Group Practice Reporting Option

In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period.  To earn an incentive for the 2013 PQRS program year, group practices may self-nominate or register to participate in GPRO via Web Interface or registry reporting.

2013 Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO): Participation for the PQRS Incentive Payment Made Simple 

This Fact Sheet provides guidance for group practices wishing to participate in the 2013 PQRS for incentive purposes under the GPRO. To view, click on the file entitled "2013 Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO): Participation for the PQRS Incentive Payment Made Simple" in the "Downloads" section below.

2013 PQRS GPRO Measures Using the Registry Reporting Method

Group practices participating in 2013 PQRS GPRO reporting via registry will be required to submit three or more individual PQRS measures on at least 80% of the group’s applicable Medicare Part B FFS patients. The “2013 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 2013 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 “2013 Physician Quality Reporting System (PQRS) Measures List”.

To select a registry vendor, refer to the “2013 Participating Registry Vendors” list on the Registry Reporting page of the CMS PQRS website

2013 PQRS GPRO Measures Using the Web Interface Reporting Method

For purposes of determining whether a group practice satisfactorily submits PQRS quality measures data for 2013, each group practice participating in the 2013 PQRS Web Interface GPRO reporting method will be required to report 18 quality measures (22 individual measures when accounting for the two composite measures). A list of the 22 2013 PQRS Web Interface GPRO reporting method measures can be found in the "2013 Physician Quality Reporting (PQRS) Group Practice Reporting Option (GPRO) Disease Modules, Care Coordination/Patient Safety and Preventive Care Measures" document. A description of each of the 22 measures can be found in the "2013 Physician Quality Reporting System Group Practice Reporting Option (GPRO) Web Interface Narrative Measure Specifications" and the updates made to the measures from 2012 can be found in the "2013 Physician Quality Reporting System GPRO Narrative Specification Release Notes" document. All documents are available in the "Downloads" section below.

2013 PQRS GPRO Requirements

CMS has posted the Group Practice Reporting Option (GPRO) requirements for Submission of 2013 Physician Quality Reporting Data.  To view click on the file entitled "2013 PQRS GPRO Requirements" in the "Downloads" section below.

2012 PQRS GPRO XML Specifications and Templates

CMS has posted the final 2012 PQRS GPRO XML specifications, 2012 PQRS GPRO XML specifications Release notes, XML templates for the 2012 GPRO Web Interface. Also included are XSD files which may be useful to GPROs for custom coding.  To view click on the file entitled "2012 PQRS GPRO XML SPECIFICATION" in the "Downloads" section below.

This zip file contains the following titled documents:

PQRS-GPRO-2012-XML-SPECIFICATION 011813.pdf
2013_PQRS_Ph4-5_GPRO_XML Spec Release Notes 020113.pdf
GproPatient_XmlToExcelTemplate.xls
GPRO-Abstract-Datatypes.xsd
PQRS-GPRO-Bene.xsd
PQRS-GPRO-Clinic.xsd
PQRS-GPRO-Discharge.xsd
PQRS-GPRO-Patient.xsd
PQRS-GPRO-Provider.xsd

2012 PQRS GPRO Web Interface Supporting Documents

CMS has posted the 2012 PQRS GPRO Web Interface User Manual. To view click on the file entitled "2012 PQRS GPRO Web Interface User Manual" in the "Downloads" section below.

2012 PQRS GPRO Supporting Documents

CMS has posted a file entitled "2012 PQRS GPRO Supporting Documents" in the "Downloads" section below.  This file contains 9 PQRS GPRO supporting documents.

2012 PQRS GPRO Training Materials

CMS-selected group practices that are participating in the 2012 Physician Quality Reporting System GPRO are required to take part in mandatory training.  The slide presentations used as training documents for these CMS-selected group practices and supporting documents will be posted in the “Downloads” section below.  These documents can be found in the zip file titled “2012 PQRS  GPRO Training Materials”

2012 PQRS CMS-Selected GPRO Requirements

This document describes the CMS-selected GPRO requirements for submission of 2012 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program data.  To view click on the document titled "2012 CMS-Selected Group Practice Reporting Option (GPRO) Requirements" in the "Downloads" section below.  

2012 PQRS CMS-Selected GPRO Measures

For purposes of determining whether a group practice satisfactorily submits Physician Quality Reporting System quality measures data for 2012, each group practice selected to participate in the 2012 Physician Quality Reporting System CMS-selected GPRO will be required to report 29 quality measures. A list of the 29 2012 Physician Quality Reporting System CMS-selected GPRO measures can be found in the "2012 Physician Quality Reporting System (Physician Quality Reporting) CMS-selected Group Practice Reporting Option (GPRO) Disease Modules, Care Coordination/Patient Safety and Preventive Care Measures" document. A description of each of the 29 measures can be found in the "2012 Physician Quality Reporting System CMS-selected Group Practice Reporting Option (GPRO) Narrative Measure Specifications" and the updates made to the measures from 2011 can be found in the "2012 Physician Quality Reporting System GPRO Narrative Specification Release Notes" document. All documents are available in the "Downloads" section below.

2011 PQRS GPRO

GPRO Requirements for Submission of 2011 eRx Data. While participation in the eRx Incentive Program (either as an individual eligible professional or under the eRx GPRO) is voluntary for group practices participating in the Physician Quality Reporting System GPRO, CMS requires that in order for a group practice to participate in the 2011 eRx GPRO, a group practice must comply with all requirements for participation in the Physician Quality Reporting System GPRO and be participating in the Physician Quality Reporting System GPRO for 2011. A group practice that wishes to participate in both the Physician Quality Reporting System GPRO and in the eRx GPRO, must notify CMS of its desire to do so when self-nominating for the 2011 Physician Quality Reporting System GPRO. The Physician Quality Reporting System GPRO requirements and instructions for submitting the self-nomination letter can be found in the "Downloads" section below. Additional information on the Physician Quality Reporting System GPRO can also be found by clicking on the "Physician Quality Reporting System GPRO" link under the "Related Links Inside CMS" section below.

For the 2011 Physician Quality Reporting System, CMS expanded upon GPRO (hereafter referred to as GPRO I) by the creation of GPRO II. GPRO II provides smaller groups (2-199 National Provider Identifier (NPIs)) the ability to report as a group practice to receive a specified percentage of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during the reporting period.

As required by section 1848(m)(3)(C)(iii) of the Act, an individual eligible professional who is a member of a group practice selected to participate in the Physician Quality Reporting System GPRO I & II are not eligible to separately earn a Physician Quality Reporting System incentive payment as an individual eligible professional under that same Tax Identification Number (TIN) (that is, for the same TIN/NPI, or NPI, combination). Once a group practice (TIN) is selected to participate in the CMS-selected GPRO, this is the only method of Physician Quality Reporting System reporting available to the group and all individual NPIs who bill Medicare under the group's TIN.

2011 PQRS GPRO I Measures.  For purposes of determining whether a group practice satisfactorily submits Physician Quality Reporting System quality measures data for 2011, each group practice selected to participate in the 2011 Physician Quality Reporting System GPRO I will be required to report 26 quality measures. A list of the 26 2011 Physician Quality Reporting System GPRO I measures can be found in the "2011 Physician Quality Reporting System GPRO I Disease Modules and Preventive Care Measures" document. A description of each of the 26 measures can be found in the "2011 Physician Quality Reporting System GPRO I Narrative Measure Specifications" and the updates made to the measures from 2010 can be found in the "2011 Physician Quality Reporting System GPRO I Narrative Specification Release Notes" document. All documents are available in the "Downloads" section below.

2011 Physician Quality Reporting System GPRO II Measures

Group practices selected by CMS to participate in 2011 Physician Quality Reporting System as a GPRO II will use the 2011 Physician Quality Reporting Measure Specifications Manual and the 2011 Physician Quality Reporting Measures Groups Specifications Manual when determining which measures to report. Both of these documents are located on the "Measures Codes" section page at left. For individual and measures groups reporting requirements, please see the GPRO II Self Nomination Requirements document, which is located in the "Downloads" section below.

GPRO Requirements for Submission of 2011 Physician Quality Reporting System Data. To participate in the 2011 Physician Quality Reporting System GPRO, a group practice must comply with certain requirements, submit a self-nomination letter to CMS, and be selected to participate in the 2011 Physician Quality Reporting System GPRO. The GPRO requirements and instructions for submitting the self-nomination letter can be found in the “Downloads” section below.

2011 Group QRURs:  Understanding Your Group’s Quality Scores In Relation to PQRS Quality Data

This document provides an understanding of how PQRS data is used in your quality scores for 2011 Group QRURs. To view this document click on the file in the "Related Link" section titled below "How-PQRS-Quality-Data-Are-Used-in-2011-Group-QRURs”.