2015 Announcements

Tune in to Twins!
Did you know the birth rate for twins has increased a whopping 76 percent since 1980? This is one of the reasons our group, the Twins & Triplets Mothers of Morris County, is growing so quickly and is actively supporting the families of twins and triplets.
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CMS Extends Deadline for Physician Quality Reporting System (PQRS) Informal Review Process
CMS is extending the 2014 Informal Review period. Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, PQRS group practices, and Accountable Care Organizations (ACOs) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment now have until 11:59 p.m. Eastern Time on December 11, 2015, to submit an informal review requesting CMS investigate incentive eligibility and/or payment adjustment determination. This is an extension from the previous deadline of November 23, 2015.

All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through December 11, 2015 at 11:59 p.m. Eastern Time.

Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment - Informal Review Made Simple (available on the PQRS Analysis and Payment webpage) for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or [email protected] Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.

New Prescription Monitoring Program Law to take effect November 1, 2015
In July, Governor Chris Christie signed Senate Bill 1998 into law (P.L.2015, c.74), which revises the scope and expands the capabilities of the New Jersey Prescription Monitoring Program (NJPMP) as of November 1, 2015. All prescribers holding CDS Registrations will need to register to access the NJPMP prior to the upcoming renewal of their CDS Registrations. If you renewed your NJ CDS registration last year, a NJPMP account was automatically created for you, but you must take some steps to activate your NJPMP account, if you have not already done so. First, you must complete a short online tutorial and then you must establish a unique e-mail address that you (the provider) check on a regular basis, which must be separate from a general office e-mail or service e-mail. Activating this account will be essential in complying with another significant provision of the new law. Unless an exemption applies, prescribers (or their delegates) will be required to review prescription monitoring information when they prescribe a Schedule II medication to a new or current patient for acute or chronic pain, the first time they prescribe and quarterly thereafter. Regulations, now being developed, will provide additional guidance with respect to this requirement. In addition, the new law expands the types of licensed professionals who are authorized to access the NJPMP for patient data (i.e., Medical Examiners, medical and dental residents and mental health practitioners). Criminal penalties for inappropriate access and misuse of NJPMP data also have been increased.

Informal Review Request Period for the 2016 Value Modifier Open Now Through November 9, 2015

The period for requesting an informal review of the 2016 Value Modifier is open now and ends November 9, 2015.

The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician eligible professional (EPs).

The 2014 Annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. For groups with 10 or more EPs that are subject to the 2016 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who bill under the group’s TIN in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2016.

Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.

For groups with 10 or more EPs that are subject to the 2016 Value Modifier, CMS established an Informal Review Period to request a correction of a perceived error in their 2016 Value Modifier calculation. These groups may request an informal review of their 2016 Value Modifier determination, now through November 9, 2015.

Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at [email protected] or 888-734-6433 (select option 3).

ICD-10 Provider Contacts for Medicare and Medicaid Questions