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Medicare FFS Physician Feedback Program/Value-Based Payment Modifier

Self Nomination/Registration

2013 Requirement for Large Group Medical Practices 
Under the Value-based Payment Modifier

New federal regulations require that medical practice groups comprised of 100 or more eligible professionals (as of October 15, 2013) will be subject to the value-based payment modifier in 2013. CMS defines a group as a single taxpayer identification number (“TIN”).  Groups of this size that fail to register and participate in the Physician Quality Reporting System (PQRS) – as a group – will see a 1% negative impact on all physician payment under the Medicare physician fee schedule in calendar year 2015. Groups meeting the size threshold must sign-up as a group during one of two sign-up periods in 2013 to participate in the 2013 PQRS. 

In order to participate in PQRS – at the group level – an authorized group representative must self-nominate/register* the group and select one of three group reporting mechanisms: 

  • the GPRO Web Interface,
  •  a qualified registry, or
  • CMS-calculated administrative claims.  

Do Not Self-nominate/Register if any of these Descriptions Apply to Your Group (TIN)

  • Medical practice groups (regardless of size) whose only payments from Medicare are from sources other than the Medicare Fee for Service Physician Fee Schedule (PFS) are not impacted by the value modifier and, thus, are NOT required to register for one of the  PQRS group reporting options. 
  • Groups not impacted by the value modifier include those that only provide care to Medicare beneficiaries who are enrolled in Medicare Advantage or
  • only practice in a Rural Health Clinic,
  • only practice in a Federally Qualified Health Center
  • only practice in a Critical Access Hospital (using method II billing)
  • Medical practice groups in which their single tax identification number (TIN) is included on CMS’s official list of participating TINs in any of the three following programs:
    • Medicare Shared Savings Program,
    • Pioneer ACO model,
    • Comprehensive Primary Care Initiative. 

 

Two Sign-Up Periods - but they are not Identical

There will be two opportunities for group practices to sign-up for one of the three group reporting mechanisms.  Regardless of which registration period you choose, your group representative will need to have a current Individual Authorized Access to CMS Computer Services (IACS) account to register for any of the three reporting options stipulated under the value modifier.  Only one person who has been authorized by your group to represent the group should access the IACS system to record your group’s selection for participating in PQRS as a group in 2013.

Your group also needs to provide the name of a second person who can also use IACS if necessary (in other words, the name of a back-up designee will be requested when you sign-up for IACS).

FIRST SELF-NOMINATION/REGISTRATION PERIOD: (December 1, 2012 – January 31, 2013) 

For purposes of meeting the value modifier requirement of  registering for one of three mechanisms of group participation in PQRS, during the12/1/2012 – 1/31/2013 timeframe group practices will be able to self-nominate and select the GPRO Web Interface or a registry reporting mechanism ONLY.  These self-nominations will be accepted through the Quality Reporting Communication Support Page (Communication Support Page) at https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.  Unlike previous program years, group practices will not be able to opt-out of reporting at the group level once they have registered; but groups will be able to change their group reporting mechanism until October 15, 2013. 

Groups wishing to participate in the 2013 Electronic Prescribing (eRx) GPRO must self-nominate during the 12/1/2012 – 1/31/2013 timeframe.  While participation in eRx is not required and does not allow groups to meet the requirements of the value modifier in 2013, groups may find it beneficial to participate in both PQRS and eRx GPRO simultaneously.  (Groups choosing to participate only in eRX, cannot self-nominate on-line, through the system described below.  These groups should e-mail PQRS Vetting@mathematica-mpr.com   

During the second self-nomination period (described more fully below), group practices will have a third option for reporting quality measures, the CMS-calculated administrative claims reporting method.  We encourage group practices to make their reporting decision early and self-nominate during the 12/1/2012 – 1/31/2013 timeframe if they choose either the GPRO Web Interface or a qualified registry.  This will allow additional time to become familiar with the reporting requirements under PQRS GPRO.

 

Steps for 2013 PQRS GPRO/VM Self-nomination period (12/1/2012 – 1/31/2013):

  1. Sign-in to the Physician and Other Health Professionals Quality Reporting Portal with an Individuals Authorized Access to CMS Computer Services (IACS) account.  If you do not have an IACS account you will be able to register for one from the same page.
  2. Once you are signed into the Portal, click the Create Self Nomination Request link located on the left side of the web page.  This will take you to the self-nomination screens on the Communication Support Page. 
  3. Select Group Practice Reporting Option {Group Practice} as the requestor type and hit submit.  Fill out the required fields on the screens that follow.  See the user manual for additional information or click the Help icon.
  4. A step-by-step overview of the process of signing up for an IACS account is available at Instructions for IACS, located in the Downloads section below.

 

SECOND SELF-NOMINATION/REGISTRATION PERIOD (July 15, 2013 – October 15, 2013):

Group practices wishing to participate in the 2013 PQRS GPRO will have a second opportunity to self-nominate between July 15th and October 15th.  In addition to being able to select a PQRS group reporting method during the 12/1/2012 – 1/31/2013 timeframe, prior registrants will be able to change their reporting method selection during the second self-nomination period.  Only during the second self-nomination/registration period will group practices will be able to select the CMS-calculated administrative claims reporting method.  Please note the CMS-calculated administrative claims method is not an option for earning the PQRS GPRO incentive payment. 

Only during the second self-nomination/registration period will group practices with 100 or more eligible professionals that have signed-up for one of the three group reporting options be allowed to elect to have their 2015 Value-based Payment Modifier be based on quality-tiering.   Quality-tiering is voluntary. Group practices that self-nominate during the 12/1/2012 – 1/31/2013 timeframe and wish to elect quality-tiering will have to make the quality-tiering election during the second self-nomination period.  Additional instructions and information will be provided later in calendar year 2013. 

Resources:

 

Additional information

The value-based payment modifier imposes no requirements on small medical practice groups or individual physicians or other eligible professionals in 2013.  They may, but are not required to self-nominate/register to participate in PQRS.

Small Groups (2-99 eligible professionals billing under a single tax identification number) may also participate in the PQRS group reporting option, and like large groups, would need to sign-up during one of the two self-nomination/registration periods.  Please note that groups with 2-24 eligible professionals do not have the option of participating through the GPRO Web Interface.

Individual physicians and other eligible professionals may choose to register for the CMS-calculated Administrative Claims Reporting Option in order to avoid a 2015 downward payment adjustment under PQRS rules.

Downloads