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PQRS Penalties and Informal Reviews: Must be completed by November 30, 2017!

Tuesday, November 21, 2017   (0 Comments)
Posted by: Jamie Klufts
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PQRS Penalties and Informal Reviews

Must be completed by November 30, 2017!


On Thursday, November 16, Rebekah Gewirtz, Jonas Goldenberg, and Erica Kirsners spoke with Mirean Coleman at NASW National to express our Chapter's dismay at the number of social worker Medicare providers who were informed that they did not report the PQRS measures successfully. Mirean agreed to ask other chapters whether their members have report these same concerns to their chapter offices. She also said that National will relay our concerns directly to CMS.
NASW-MA STRONGLY recommends that all LICSWs who received a letter from CMS, with the headline: “An Important Message for the Centers for Medicare & Medicaid Services About the Physician Quality Reporting System (PQRS) Payment Adjustment,” IMMEDIATELY file a “Request for Informal Review” with CMS. 
It is important to do this in order to let CMS know that we object to their penalizing us 2% for not being able to follow their complicated PQRS instructions.
To request an informal review, visit:, then select “Informal Review Request” and choose the appropriate option (more detailed instructions below). You only have until end of day on November 30, 2017 to file this request.
Step 1: Access your 2016-PQRS Payment Adjustment Measure Performance Detail Report. To get your report explaining exactly why you will be penalized, go tohttps://portal.cms.govIt is useful to do this in order to determine the rationale for the penalty.
On the right: CMS Secure Portal – Log in the CMS Secure Portal and Take the Following Steps:
  • I Accept
  • User ID – Next (there is a “forgot user ID” option)
  • Password (there is a “forgot password” option)
  • Device type (personally, I found email easiest)
  • Send
  • Retrieve and put in the security code
  • Log in
  • On the right: Request Access now
  • Yellow drop down box PV-PQRS Feedback reports
  • Select a year: 2016
  • Select a Report: PQRS Payment Adjustment Measure Performance Detail Report for Individuals
  • Select an Action: Download this report (so that you will be able to send it to us)
  • Click HIPAA Covered Entity; I confirm
  • Double click on your NPI
  • Scroll all the way down to Export
Step 2: Send your 2016-PQRS Payment Adjustment Measure Performance Detail Report to Jonas at Jonas will collect all of these and send them to Mirean Coleman, NASW National; Lawrence Clark, Medical Director of NGS; and Pierre Yong, Director of Quality Measurement at CMS. NASW-MA will be suggesting that NGS/CMS reconsider the penalties incurred by our chapter members.
Step 3File an Informal Review.
  • Go to
  • On the left hand side you will see a related link box.
  • Click on the Communication Support page link, then PQRS Informal Review.
  • Fill out all fields with asterisks next to them and then click submit.
  • You will receive a notification with an Informal Review ID. Make sure you receive this ID for confirmation that your Informal Review was received.
  • Please allow 90 days for a response.
  • If CMS does not grant your Informal Review, you will not be able to file again.




If you have any questions, contact the QualityNet Help Desk


Helpful CMS & PQRS Resources


Thank you to Erica Kirsners, LICSW, for creating the directions for checking on your penalty and submitting an “Informal Review.”



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