Group Practice Reporting Option
In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), the Centers for Medicare & Medicaid Services (CMS) created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices participating in PQRS GPRO that satisfactorily report data on PQRS measures for a particular reporting period may avoid a negative PQRS payment adjustment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (MPFS) allowed charges for covered professional services furnished during the reporting period.
To avoid the 2017 payment adjustment by reporting during the 2015 PQRS program year, group practices participating in GPRO may register to participate via:
- Qualified PQRS registry
- Web Interface (for groups of 25+ only)
- Direct electronic health record (EHR) using certified EHR technology (CEHRT)
- CERHT via Data Submission Vendor
- CAHPS via CMS-certified survey vendor to supplement reporting
Registration: The Physician Value-Physician Quality Reporting System (PV-PQRS) registration system will be available April 1, 2015 through June 30, 2015 and can be accessed at the CMS Portal. The PV-PQRS registration system allows group practices to register to participate in the PQRS GPRO in 2015 via qualified PQRS registry, Web Interface (for groups with 25 or more eligible professionals [EPs] only) or using an EHR. In order to register, groups must have an approved Individuals Authorized Access to the CMS Computer Services (IACS) account and indicate their reporting mechanism for the 12-month period. The 2015 PQRS data submission window will be in the first quarter of 2016.
See the 2015 PQRS GPRO Registration Quick-Reference Guide. If you have questions about how to register or set up an IACS account please contact the QualityNet Help Desk at 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7 AM- 7 PM Central Time. Please note that groups must have an approved IACS account to register for one of the PQRS GPRO options. It can take up to 24 hours for a group to receive approval for their IACS account; therefore, groups wishing to register should make sure their IACS accounts are approved as soon as possible.
2015 PQRS GPRO Requirements
The PQRS GPRO 2015 Criteria document outlines the criteria for participating in 2015 PQRS via GPRO. The document outlines how to determine group size, criteria for participation via GPRO, registration information, and resources for additional information about the 2015 PQRS GPRO.
2015 PQRS GPRO Measures Using the Registry Reporting Method
Group practices participating in 2015 PQRS GPRO reporting via registry will be required to submit 9 or more individual PQRS measures on at least 50% of the group’s applicable Medicare Part B FFS patients. If fewer than 9 measures or if less than 3 National Quality Strategy (NQS) domains are reported via a qualified registry, CMS will apply a measure-applicability validation (MAV) process when determining satisfactory reporting and subjectivity to the negative payment adjustment. Refer to MAV information available on the Analysis and Payment page.
The “2015 Physician Quality Reporting System (PQRS) Claims/Registry Measures Specifications Manual” is to be used for this method of reporting and can be found on the Measures Codes page of the CMS PQRS website. The 2015 measures specifications include codes and reporting instructions for PQRS claims- and registry-based reporting. A list of measures available for registry reporting can be found in the “2015 Physician Quality Reporting System (PQRS) Measures List” on the Measures Codes page of the CMS PQRS website.
2015 PQRS GPRO Measures Using the Web Interface Reporting Method
For purposes of determining whether a group practice participating in GPRO satisfactorily submits PQRS quality measures data for 2015, each group practice participating in the PQRS GPRO Web Interface reporting method will be required to report 17 quality measures.
A description of each of the 17 measures can be found in the “2015 GPRO Web Interface Narrative Measure Specifications” and the updates made to the measures from 2014 can be found in the Release Notes document. Both of these documents as well as additional supporting documents can be found on the PQRS GPRO Web Interface page.
2015 GPRO Reporting for Vendors Using an EHR
An intermediate-level fact sheet is now available on 2015 GPRO reporting for vendors who use an EHR. This includes information about how EHR Direct and Data Submission Vendors should report 2015 PQRS for group practices participating in PQRS GPRO. EHR vendors wishing to participate in the 2015 PQRS and submit data for groups participating in PQRS GPRO should review the 2015 GPRO Guide for EHR Direct and EHR Data Submission Vendors document.
Group practices participating in 2015 GPRO and reporting using an EHR will need to work directly with their EHR Direct or Data Submission Vendor.
2015 Guide for Group Practices Participating via PQRS GPRO Using an EHR
A beginner-level fact sheet about 2015 GPRO reporting using an EHR is now available for group practices. This was developed to assist group practices participating in GPRO reporting using a direct EHR product or Data Submission Vendors. Group practices participating in GPRO and reporting using an EHR should review the 2015 Guide for Group Practices Using PQRS GPRO Reporting Using an EHR document and work directly with their EHR Direct or Data Submission Vendor.
If reporting for PQRS through another CMS program (such as the Medicare Shared Savings Program, Comprehensive Primary Care Initiative, Pioneer Accountable Care Organizations), please check the program’s requirements for information on how to report quality data to earn a PQRS incentive and/or avoid the PQRS payment adjustment. Please note, although CMS has attempted to align or adopt similar reporting requirements across programs, eligible professionals should look to the respective quality program to ensure they satisfy the PQRS, EHR Incentive Program, Value-based Payment Modifier (Value Modifier), etc. requirements of each of these programs.
- Page last Modified: 05/18/2015 5:35 PM
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