Of Note: 

2013 PQRS Informal Review Process Open Until Feb. 28, 2015

If an eligible professional (EP) or group practice believes they received an incorrect Physician Quality Reporting System (PQRS) payment penalty letter from the Centers for Medicare and Medicaid Services (CMS), they now have the ability to verify the information without calling the CMS Help Desk by utilizing CMS' new PQRS Look Up tool. The PQRS Look Up tool is connected to the same files the CMS Help Desk accesses to verify whether an EP is subject to the 2015 PQRS payment adjustment or should have received a 2013 PQRS incentive. To utilize the tool, EPs and practices will need to type in their Tax Identification Number (TIN) or TIN/ National Provider Identifier (NPI) combo.

If an EP or group practice feels they are receiving a PQRS payment adjustment in error, they will need to file an Informal Appeal by February 28, 2015. EPs, designated support staff/vendors, and group practices who submit data for the PQRS program can request to have an informal review of their PQRS reporting performance through the Communication Support Page.

An informal review may be requested for any of the following reasons:

  • A practice's PQRS feedback report indicates that the EP or group practice did not earn the PQRS incentive payment when they believe they should have;
  • A practice believes the PQRS payment amount was incorrect; or A practice received a notification in error from CMS indicating the EP or group practice did not successfully participate in 2013 PQRS and will receive a 2015 PQRS payment adjustment.


Summary of Key Provisions in 2015 Medicare Physician Fee Schedule Final Rule

Topics Include

Avoid the 2016 PQRS Medicare Claims Penalty:

To avoid being penalized 2% on all of your 2016 Medicare claims, you must have reported the necessary quality measures pertinent to psychiatry for at least 50% of your eligible patients by December 31, 2014. If you did not fulfill the PQRS (Physician Quality Reporting System) requirements for reporting on quality measures in 2013 (only one measure needed to be reported that year) you will receive a 1.5% downward adjustment on all of your Medicare claims in 2015.

for your 2015  Medicare Fee Schedule go to your contractor's website.

Contractor Directory available for APA members here.

Received a Revalidation Request Letter? Now What?

Have you received the yellow envelope containing a request to revalidate?  
   • Prevent payment hold and deactivation of billing privileges by responding timely.
   • Submit a completed revalidation application as soon as possible, but no later than 60 days from the postmark date on the revalidation request letter.

Do you want to revalidate using the quickest and easiest method?

   • Use PECOS
   • Submit your revalidation via the Internet-based secure Provider Enrollment Chain & Ownership System (PECOS) rather than a CMS-855 paper application. The process is as easy as verifying your information in PECOS, making changes where needed, uploading supporting documents, and signing the application electronically. 
   • For details and helpful tips, visit the Enrollment section of your Medicare Administrative Contractor's website. [Web links are vailable on the MAC Directory]

So you have never used PECOS or haven't accessed PECOS lately?

   • Get started and revalidate in PECOS.

2% Sequestration Medicare Fee Cut:

As of April 1, 2013, Medicare fees were effectively cut by 2% as part of the overall federal cuts required by sequestration. For participating providers, patients will still be required to pay the same copay they paid before sequestration (even though the percentage of the total will be slightly higher than it was since the amount received from Medicare will be lower), but the provider will receive 2% less from Medicare. Nonparticipating providers may continue to charge patients the limiting charge for the service, and the 2% will be subtracted from the reimbursement they get from Medicare.


Medicare was created in 1965 as part of the Social Security Act.  The program was divided into two parts.  Part A is hospital insurance and helps to pay for care provided in a hospital, skilled nursing facility, nursing home, or hospice.  It covers the room, board, and ancillary charges billed directly by the facility.  Part B covers the professional services of physicians and nonphysician healthcare providers and a variety of outpatient services including x-rays, laboratory work, and durable medical equipment. Since 2006 there has also been a prescription drug benefit that Medicare beneficiaries can buy into known as Medicare Part D.

Practice help is available to Members through the Practice Management HelpLine by phone [800.343.4671] or email us at

Medicare Participation: Know Your Options

Enrollment in Medicare


Electronic Health Records Meaningful Use

Medicare e-Prescribing Program

Medicare Fee Schedule

Medicare Part D

Troubleshooting Medicare

Medicare vs. Medicaid

Information on Medicaid

More online/print practice resources supported by OHSF:

Quick Practice Management Guides – Documents exploring common practice management issues encountered by psychiatrists.

Practice Management for Psychiatrists: The Basics   The  e-book is posted both as a single document download and as a chapter-by-chapter download for ease of printing. Free online to Members.

Information on Mental Health Parity can be found on the APA website under Managing A Practice or on the APA co-sponsored site