Attention: Negative PQRS Payment Adjustment for 2017



Mirean Coleman, LICSW, CT
Senior Practice Associate
October 2016

The Centers for Medicare and Medicaid Services (CMS) has distributed letters to
clinical social workers and other Medicare providers regarding the 2017 Physician
Quality Reporting System (PQRS) negative payment adjustment. The letter
informs clinical social workers whether they will receive a 2017 negative payment
adjustment for not satisfactorily reporting 2015 PQRS quality measures and as a
result, will receive a two percent decrease in reimbursement for 2017 Medicare

Part B services.
Clinical social workers may access their 2015 PQRS Feedback Report at the CMS
Enterprise Portal:
After reviewing their 2015 PQRS feedback report, clinical social workers who
believe they received a 2017 PQRS negative payment adjustment in error, should
submit an informal review request no later than November 30, 2016, 11:59 pm
Eastern Standard Time. CMS will investigate your request to determine its merits
and make a decision within 90 days of your request. An informal review must be 
submitted at the following Web site: Quality Reporting Communication Support

NASW encourages its members who received a 2017 negative payment
adjustment letter to give this matter their prompt attention. If a negative
adjustment was received in error, file an informal review immediately. NASW has
been informed by members that they may have been inappropriately penalized
for not using measures which were beyond the scope of practice for social
workers. If so, filing an informal review would be warranted. As a reminder, the
following NASW link provides examples and instructions for 2015 PQRS measures
relevant to clinical social workers:

For additional information and assistance, clinical social workers may contact the
QualityNet Help Desk by phone at 1-866-288-8912 or by email at from 7:00 am to 7:00 pm, Central Time, Monday through