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News and Announcements

Medical Practice Group QRURs

Starting September 16, the 2012 Quality and Resource Use Reports (QRURs) will be available for medical practice groups nationwide with 25 or more eligible professionals (EPs) who share a single tax identification number (TIN). QRURs will contain quality of care and cost performance data for calendar year 2011 on measures that will be used to compute the value-based payment modifier. These reports will be available via the Physician Value- Physician Quality Reporting System (PQRS) registration system at: https://portal.cms.gov   

Registration

The Physician Value-Physician Quality Reporting System (PV-PQRS) registration system is open until October 18, 2013 at https://portal.cms.gov. The PV-PQRS registration system allows groups to select their PQRS reporting mechanism for CY 2013, and for groups with 100 or more eligible professionals (EPs), to elect quality tiering to calculate the Value Modifier for CY 2015.  Additionally, individual EPs will be able to select the CMS-calculated administrative claims reporting mechanism in CY 2013 in order to avoid the PQRS negative payment adjustment in CY 2015.  Please access the following link for more details: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Self-Nomination-Registration.html .

What Should You Do in 2013?

  • Participate in PQRS quality reporting.  In calendar year 2013, medical practice groups of 100 or more eligible professionals (all of whom file Medicare Fee-For-Service claims under the physician fee schedule using a single tax identification number) must register and participate in PQRS as a group in order to avoid a negative one percent payment adjustment (in 2015) under the value modifier.
  • If you practice in a group of 100 or more eligible professionals, your group will need to self-nominate/register to report quality measures in one of three ways.  From December 1, 2012 through January 31, 2013, groups can self-nominate to participate in the PQRS web-interface group reporting option or the group registry option. Beginning again in July and lasting until mid-October, CMS will continue the self-nomination/registration process for groups of 100 or more eligible professionals to tell us which of the three mechanisms of group reporting they will use for 2013 to avoid a negative 1% payment adjustment under the value modifier.
  • During a second self-nomination/registration period (July-October 18, 2013) groups of any size, as well as individual eligible professionals can request that CMS calculate their quality performance based on administrative claims.  The CMS-calculated administrative claims reporting option requires no effort beyond signing up. Large groups (with 100 or more eligible professionals billing under a single TIN) can avoid both a negative 1% value modifier fee adjustment and avoid a negative  1 .5% PQRS payment  adjustment in 2015. For small groups and individuals, signing up for the CMS-calculated administrative claims reporting  option will also avoid a negative payment adjustment in 2015 that would be imposed for not participating in PQRS. In 2013, neither individuals nor groups of fewer than 100 eligible professionals are subject to the value modifier. Small groups and eligible professionals choosing the CMS-calculated administrative claims reporting option would use the same July-October 2013 self-nomination process as large groups. Please note, groups and individuals who sign up for the CMS-calculated administrative claims reporting option will not earn a PQRS incentive payment. 
  • Individual reporting of PQRS measures does not meet the requirement for group participation in PQRS (even if every member of the group participates). If individuals choose to participate in PQRS at the individual level in order to earn a payment incentive, the group, as a whole, must still/also sign up in 2013 for one of the three PQRS group reporting options that will allow the group to avoid a negative 1% payment adjustment under the value modifier in 2015.
  • During the second sign up period (July-October), large groups that are subject to the value modifier also will have an opportunity to elect a Quality Tiering option to calculate the 2015 value modifier for their group, based on quality and cost performance in 2013. In most cases the result of electing quality tiering (which is voluntary in 2013) would be a neutral value modifier (with no impact on payment).  High quality and low costs could result in a positive value modifier and an upward adjustment in 2015 payments. Conversely, if quality was low and costs were high, the result could be negative payment adjustments of 1%. Not signing up for PQRS group reporting would result in a negative 1% payment adjustment for groups that are subject to the payment modifier, regardless of whether or not the group elected quality tiering.
  • Some of the information in the QRURs and posted on Physician Compare is based on how you describe your specialty, practice, and location in the Provider Enrollment, Chain and Ownership System (PECOS). Update all information about you and your practice in PECOS. Go to https://pecos.cms.hhs.gov/pecos/login.do.
  • When you receive a confidential QRUR, review it and help us improve future reports by offering input and suggestions.