Reconsideration Overview - Hospital OQR Program

If the Centers for Medicare & Medicaid Services (CMS) determines that a hospital did not meet the Hospital Outpatient Quality Reporting (OQR) Program requirements for Calendar Year (CY) 2019, the hospital may submit a request for reconsideration to CMS by the first business day on or after March 17, 2019; thus, this year, reconsideration requests must be received on or before March 18, 2019. The request must identify the hospital’s specific reason(s) for believing it did meet the Annual Payment Update (APU) requirements and should receive the full CY 2019 APU.

The procedure for submitting the reconsideration request is detailed in the Hospital OQR Reconsideration Process for CY 2019 APU Decisions.

Hospitals requesting reconsideration will receive an email confirming receipt of their reconsideration request form. Once the reconsideration process is complete, CMS will officially respond with the outcome of the request.

If a hospital fails to submit a reconsideration request to CMS by the deadline, the hospital will not subsequently be eligible to file an appeal with the Provider Reimbursement Review Board.

If a hospital is dissatisfied with the result of the Hospital OQR Program reconsideration, the hospital may file a claim under 42 CFR Part 405, Subpart R (a Provider Reimbursement Review Board [PRRB] appeal). Details are available at PRRB Review Instructions.

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