Frequently Asked Questions

This section answers frequently asked questions about publicly reported information for doctors and clinicians on Medicare Care Compare and in the Provider Data Catalog (PDC).

You are welcome to send feedback and questions to QPP@cms.hhs.gov.

Publicly Reported General and Performance Information

  • What types of information are available for doctors, clinicians, and groups on Care Compare and in the PDC
  • Do all Medicare doctors, clinicians, and groups have Care Compare profile pages?
  • How is doctor, clinician, and group performance information displayed on Care Compare profile pages?
  • How is Alternative Payment Model (APM) participation and performance information publicly reported on Care Compare and in the PDC?
  • Can doctors, clinicians, and groups preview their performance information before it is publicly reported on their Care Compare profile pages and in the PDC

About the Data

  • How often are general and performance information about doctors, clinicians, groups, and ACOs on Care Compare and in the PDC updated?
  • What data sources are used for doctors, clinicians, and groups on Care Compare and in the PDC?
  • Is there a downloadable database of all the information currently available on Care Compare profile pages for doctors, clinicians, and groups?
  • How do I update general information about my group or myself?
  • How do I remove personal contact information?

Care Compare: Doctors and Clinicians and the Provider Data Catalog

  • What is the history of public reporting performance information for Medicare doctors, clinicians, and groups?
  • What is the statutory authority for publicly reporting information about Medicare doctors, clinicians, and groups?

Publicly Reported General and Performance Information

What types of information are available for doctors, clinicians, and groups on Care Compare and in the PDC

Care Compare and the PDC include Quality Payment Program performance information and other general information for Medicare doctors, clinicians, and groups. To learn more about performance information selected for public reporting, refer to the following documents:

Some of the general information on Care Compare profile pages includes:

General Information

 

Information

Doctors and Clinicians

Groups

Name

Addresses and phone numbers

Medical specialties

Medicare assignment status

Board certifications

 

Education and residency

 

Gender

 

Group affiliation

 

Hospital affiliation

 

Affiliated clinicians

 

ACO affiliation

 

Do all Medicare doctors, clinicians, and groups have Care Compare profile pages?

Only doctors, clinicians, and groups who meet the following criteria will have profile pages on Care Compare:

  • Have at least one practice location address in the Provider Enrollment, Chain, and Ownership System (PECOS);
  • Have at least one specialty in PECOS;
  • Have submitted a Medicare claim within the last six months or be newly enrolled in PECOS within the last six months; and
  • Groups must have at least two active Medicare clinicians reassigning their benefits to the group’s tax identification number (TIN).

How is doctor, clinician, and group performance information displayed on Care Compare profile pages?

Performance information for doctors and clinicians is displayed using measure-level star ratings, percent performance scores, and checkmarks. Specific information about how this performance information is publicly reported can be found here:

How is Alternative Payment Model (APM) participation and performance information publicly reported on Care Compare and in the PDC?

Information about 2018 APM participation is reported in the following ways:

  • Next Generation or Medicare Shared Savings Program (Shared Savings Program) ACOs will continue having profile pages with measure-level performance scores for a subset of their quality measures on Care Compare.
  • Groups that participated in Next Generation or Shared Savings Program ACOs will have an indicator of APM participation on their group Care Compare profile page; their profile will also link groups to their affiliated ACO Care Compare profile pages.
  • Clinicians and groups will have an indicator of APM participation on their Care Compare profile pages, if they participated in the selected APMs.
  • Clinicians who participated in an APM and submitted performance information as individual clinicians in 2018 may or may not have individual performance information available on their Care Compare profile pages.

For more information about APMs and public reporting, download the following documents:

Can doctors, clinicians, and groups preview their performance information before it is publicly reported on their Care Compare profile pages and in the PDC

All doctors, clinicians, and groups with performance information targeted for public reporting on Care Compare profile pages and in the PDC will be able to preview their data before it is published. The Doctors and Clinicians Preview Period is an opportunity for doctors and clinicians to see their performance information before it is publicly reported. The Doctors and Clinicians Preview Period will be announced via the Care Compare: Doctors and Clinicians listserv and other stakeholder listservs, as well as the Care Compare: Doctors and Clinicians Initiative page.

ACOs are able to review their annual performance information via their Quality Performance Reports.

About the Data

How often are general and performance information about doctors, clinicians, groups, and ACOs on Care Compare and in the PDC updated?

General information for doctors, clinicians, and groups, such as addresses and phone numbers, is updated twice a month. Their performance information is updated on an annual basis. ACO performance information is also updated on an annual basis.

What data sources are used for doctors, clinicians, and groups on Care Compare and in the PDC?

Performance information for doctors, clinicians, and groups comes from the Quality Payment Program. General information is primarily from PECOS. Some of the information in PECOS, such as group affiliations and practice locations, is obtained or verified using claims data. Board certification is derived from certification and accrediting organizations such as the American Board of Medical Specialties, the American Osteopathic Association, the American Board of Optometry, and the American Board of Wound Medicine and Surgery.

Is there a downloadable database of all the information currently available on Care Compare profile pages for doctors, clinicians, and groups?

The PDC is currently available on Data.Medicare.gov and contains general and performance information publicly reported on doctor and clinician profile pages on Care Compare. Additional performance information such as Final Scores and performance category scores is also available in the PDC.

How do I update general information about my group or myself?

Much of the information can be updated in PECOS. Once you update PECOS, the changes will be reflected on Care Compare profile pages and in the PDC in two to four months, the amount of time it takes for the information to be verified and processed.

Individual clinicians can update their first and last name, gender, specialty, education, and group affiliation via PECOS. To update residency, board certification, and hospital affiliation, please send an email with your name, NPI, and request to QPP@cms.hhs.gov.  

Groups can update their legal business name, affiliated clinicians, and addresses via PECOS. Groups should email QPP@cms.hhs.gov if they would like to have a “Doing Business As” (DBA) name appear on their Care Compare profile page.

How do I remove personal contact information?

If your personal information such as phone numbers or addresses is displaying on your Care Compare profile page, send us an email with the correct contact information so we can make a manual edit to your profile page. The manual edit quickly removes this information from the website; however, the manual edits remain in effect for six months only. Therefore, you also need to update this information via PECOS to ensure your personal information will not repopulate in the future. We recommend you make the update as soon as possible.

Care Compare: Doctors and Clinicians and the Provider Data Catalog

What is the history of public reporting performance information for doctors, clinicians, and groups?

Consistent with the Affordable Care Act, CMS first started a phased approach to public reporting on Physician Compare, Care Compare’s predecessor website focused on public reporting for doctors and clinicians, beginning with the 2012 Physician Quality Reporting System (PQRS) performance information. CMS expanded the number and types of performance information available on Physician Compare. The Medicare and Chip Reauthorization Act (MACRA) of 2015 extended this authority. In 2019, the first Quality Payment Program performance information (performance year 2017) was publicly reported on Physician Compare. In 2020, CMS transitioned to publicly reporting performance information on Care Compare and in the PDC. The most current performance information available for doctors, clinicians, groups, and ACOs is the performance year 2018 Quality Payment Program performance information.

What is the statutory authority for publicly reporting information about Medicare doctors, clinicians, and groups?

Physician Compare and its successor, Care Compare: Doctors and Clinicians and the PDC, draw operating authority from Section 10331(a)(1) of the Affordable Care Act. Under this authority, CMS developed Physician Compare and initiated a phased approach to public reporting. Section 1848(q)(9)(A) and (D) of MACRA facilitates the continuation of this phased approach for publicly reporting doctor and clinician performance information.

We are required to report MIPS eligible clinicians’ final score, MIPS eligible clinicians’ performance under each MIPS performance category, names of eligible clinicians in Advanced APMs and, to the extent feasible, the names and performance of such Advanced APMs. We are also required to publicly report aggregate information on MIPS, including the range of final and performance category scores for all MIPS eligible clinicians, periodically.

Page Last Modified:
02/22/2021 02:39 PM