CMS Pub. 100-22, ch. 1, § 80

Section 1848(m)(5)(E) of the Act, except for the informal review process noted below, there is

no administrative or judicial review or otherwise of the determination of: (1) the determination of

quality measures applicable to services furnished by eligible professionals, (2) the determination

of satisfactory reporting, or (3) the determination of any incentive payment.

However, section 1848(m)(5)(I) of the Act, as added by the Affordable Care Act, requires the

establishment of an informal review process by January 1, 2011. As such, beginning with the

2011 Physician Quality Reporting System, eligible professionals may seek an informal review of

the determination that an eligible professional or group practice did not satisfactorily submit data

on quality measures under the Physician Quality Reporting System. To request an informal

review, an eligible professional or group practice must submit a written request to CMS within

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90 days of the release of the applicable year’s feedback reports. The request must state the

eligible professional’s or group practice’s reasons for requesting an informal review which may

include information to assist in the review. CMS will provide a final, written response to the

request within 60 days of the receipt of the original request. With respect to an informal review

request received in 2012 based on 2011 data, CMS will provide a final, written response to the

request within 60 days of the receipt of the original request. With respect to an informal review

request received in 2013 based on 2012 data and subsequent years, CMS will provide a final,

written response to the request within 90 days of the receipt of the original request. All decisions

are final and are not subject to further review.