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Topic starter
We did a lot of work to fulfill Meaningful Use and PQRS for the 2015 year and submitted everything via QSS. I never heard anything from either GE nor the government aside from the EHR hardship email which we were accepted.
Today I get a call from billing stating that we are being docked for 2015 PQRS. I don't even know what to think... Where do I even begin? I called our GE rep and left a voicemail... just thinking about all that work... for nothing and a negative percentage back... it makes me sick.
Posted : February 1, 2017 10:11 am
I just heard the same thing today from our ops mgr. Apparently we were being docked last year as well for a couple of providers that should not have been (including providers that should have been excluded like physical therapists as well as a new to us provider) and no one noticed until today.
Posted : February 1, 2017 3:52 pm
Are you sure the 2% penalty was for failing PQRS? Another possibility is the penalty is from your QRUR (Value Modifier) score. This is another program where they add your PQRS score and your Medicare charges and compare you to others.
Here is a paragraph I copied from a website that may explain it a bit better:
Payment adjustments may be applied if eligible providers (EPs) do not successfully report PQRS or through quality-tiering for those who do report PQRS. However for the 2015 reporting year/2017 payment adjustment year, solo providers and groups with 2-9 providers will not receive a VM penalty under quality tiering, but may have a VM penalty if not reporting PQRS. Groups with 10 or more providers may receive an upward, neutral or downward adjustment under quality tiering.
Posted : February 2, 2017 2:26 am
Topic starter
yea, there is an additional penalty, 4% altogether. Talk about frustrating.
Posted : February 2, 2017 7:52 am
We are docked for providers that are new to us also. How was a I supposed to file for them when they didn't work for us two years ago. I am equally frustrated. Is there a way they are supposed to be excluded? We also did MU and PQRS.
Posted : February 7, 2017 6:18 am
Topic starter
They don't make it easy to talk to them. One would think that being that I have a EIDM account that is all I would need. I have to send them more information to sign up for more accounts, this is crazy. I'm going to try again tomorrow.
Posted : February 7, 2017 10:19 am
A similar thing happened to us last year. We received a letter from CMS stating that one of our providers did not meet PQRS and was going to be penalized. GE Rep was our first stop, then it was escalated to the regional GE Acct Mgr and senior level tech support. So what happened? GE submitted another provider's (failing) numbers under the name of ours!!! Yeah... really. Long story short, I worked to get an informal review then appeal process with CMS to no avail. After "talks" with GE, we were reimbursed for my time and the penalty amount for all of 2016. We are waiting 2017's submission with bated breath.
Different story than yours (I hope?), but one to show some part of this complex process can go stray. GE Rep is stop #1. While you're waiting, go onto the CMS portal and view your QRUR data as others suggested. Download the reports and see what's in there. If you don't hear back from GE Rep in 24 hours, I'd escalate. Keep pushing until you get an answer. You're the PAYING customer!
Good luck.
Posted : February 8, 2017 1:14 am
Topic starter
Thanks Sam. Strangely, we never received anything from CMS, just the penalty now. I went over a few things with GE in the dashboard and there is no evidence that anything went out, however I did everything by GE's instruction during a webex. I went over the QRUR with CMS and they stated that nothing was submitted. I'm going to call PQRS this morning to see if there is anything we can do. It doesn't make sense unless something happened with the dashboard and it didn't actually submit on our behalf but one would think that GE would be on top of that being that we are a paying customer.
Posted : February 8, 2017 1:20 am
