Quality Reporting and Payment Reduction
Q: I went to the CMS site to check my NPI and was informed that I did not meet the requirements for quality reporting and was therefore exempt from participation. Now I have received a letter from CMS saying there will be a 2% payment reduction. What is going on?
A: One VERY important thing to consider is the year that you checked your status. This is because the reporting threshold and requirements have changed over the years and there is a 2 year lag between reporting and payment adjustments. If you checked recently, then the reporting threshold is actually higher so you could very likely be exempt for 2017 which would affect payments for 2019 (because of the 2 year lag). HOWEVER, if the year in question you DID meet the requirements for reporting and you did not, then the adjustment would rightly apply.
At this point, to be sure that this is NOT an administrative error, the best thing to do would be to contact your MAC, the QualityNet HelpDesk (1-866-288-8912 or Qnetsupport@hcqis.org). You also should log into the PQRS Portal at https://portal.cms.gov/wps/
Be sure to document your conversation and all contact with them to ensure that you have supporting evidence should further questions arise.