Group Practice Reporting Option (GPRO)


PQRS defines a group practice as a single Tax Identification Number (TIN) with two or more individual EPs (as identified by Individual National Provider Identifier [NPI]) that have reassigned their billing rights to the TIN. Eligible professionals in group practices with two or more can register with CMS to report PQRS data through the group practice reporting option (GPRO). PQRS group practices must register for their selected reporting mechanism by June 30, 2015 through the PV-PQRS registration portal. Please note that a valid IACS account will be needed in order to register. Review the reporting options below prior to registering. An individual EP who is a member of a group practice participating in PQRS GPRO is not eligible to separately earn a PQRS incentive payment as an individual EP under that same TIN (that is, for the same TIN/NPI combination). Once a group practice (TIN) registers to participate in the GPRO, this is the only PQRS reporting method available to the group and all individual NPIs who bill Medicare under the group’s TIN. Groups that register as a GPRO will not be able to change or update their registration after the deadline.

NEW for 2016: Group practices of 2+ EPs participating in the GPRO have the option to report quality measures via QCDR.
PQRS group practices choosing to participate in PQRS via QCDR must submit a valid registration by June 30, 2016. Registration must be completed online through the Physician Value Modifier (PV) - PQRS Registration System. For additional information on PQRS group practice QCDR registration and requirements please refer to the “2016 PQRS GPRO Registration Quick Reference Guide” that will be located on the PQRS How to Get Started webpage during the first quarter of 2016.

Note: Groups with two or more EPs that choose not to register as a GPRO can still avoid the 2017 PQRS payment adjustment and the Value Based Payment Modifier (VBPM) adjustment by ensuring that at least 50% of the EPs in the group fulfill the individual PQRS reporting criteria. Reporting through an individual reporting mechanism does not require registration with CMS.

1. Individual Measures via Qualified Registry (2-99 EPs)
• Report at least nine measures, covering at least three of the NQS domains. Of these measures, if a group practice sees at least one Medicare patient in a face-to-face encounter, the group practice would report on at least one measure in the cross-cutting measure set.
• If less than nine measures covering at least three NQS domains apply to the group practice, the group practice would report up to eight measures covering 1-3 NQS domains for which there is Medicare patient data, and report each measure for at least 50% of the group's Mediare Part B FFS patients seen during the reporting period to which the measure applies and will be subject to Measure-Applicability Validation (MAV) process. Measures with a 0 percent performance rate would not be counted.
• If the group practice chooses to report CAHPS for PQRS, the following criteria apply: Must participate via CMS-certified survey vendor to have 12 CAHPS for PQRS survey measures administered to eligible beneficiaries seen during the 12-month reporting period. Must report at least six additional measures, outside of CAHPS for PQRS, covering at least two NQS domains. If less than six measures apply, five measures must be reported and the MAV process will be applied. If an EP in the group sees at least one Medicare patient face-to-face, the group must report one cross-cutting measure.
• Find individual measures available for registry reporting here.

2. Individual Measure + CAHPS for PQRS via Qualified Registry and CMS-Certified Survey Vendor (100+)
Note: Group practices with 100 or more EPs reporting through the GPRO Web Interface will be required to report the CAHPS for PQRS measures through a CMS-Certified Survey Vendor in addition to satisfactorily reporting PQRS measures via the GPRO Web Interface. CMS will not bear the cost of administering this required survey.
Additional Note: The CAHPS for PQRS survey is equal to three individual measures and one NQS domain.
• The group practice must have all CAHPS for PQRS survey measures reported on its behalf via a CMS-certified survey vendor, and report at least six additional measures, outside of CAHPS for PQRS, covering at least two of the NQS domains using the qualified registry. Of the additional measures that must be reported in conjunction with reporting the CAHPS for PQRS survey measures, if any eligible professional in the group practice sees at least one Medicare patient in a face-to-face encounter, the group practice must report on at least one measure cross-cutting measure.
• If less than six measures apply to the group practice, the group practice must report up to five measures and will be subject to the Measure-Applicability Validation (MAV) process.
• Find individual measures available for registry reporting here.

3. Individual Measures via GPRO Web Interface (25-99)
• Report on all measures included in the web interface; AND populate data fields for the first 248 consecutively ranked and assigned beneficiaries in the order in which they appear in the group's sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 248, then the group practice must report on 100 percent of assigned beneficiaries. A group practice must report on at least one measure for which there is Medicare patient data.
• In addition, the PQRS group practice choosing to take part in the PQRS GPRO Web Interface may additionally choose to participate in CAHPS for PQRS. If that election is made, the group practice must also report all CAHPS summary survey modules via a CMS-certified survey vendor (CAHPS for PQRS). CMS will not bear the cost of administering.
• If the group practice chooses to report CAHPS for PQRS, the following criteria apply: Must participate via CMS-certified survey vendor to have 12 CAHPS for PQRS survey measures administered to eligible beneficiaries seen during the 12-month reporting period. Must report all 21 measures within the GPRO Web Interface and populate date fields for the first 248 consecutively ranked and assigned beneficiaries. If less than 248 beneficiaries are available, groups must report on 100 percent of assigned beneficiaries. At least one measure containing Medicare patient date must be reported.
• Click here to review the GPRO web interface measures and other resources.

4. Individual Measure + CAHPS for PQRS via GPRO Web Interface and CMS-Certified Survey Vendor (100+)
• Note: Group practices with 100 or more EPs reporting through the GPRO Web Interface will be required to report the CAHPS for PQRS measures through a CMS-Certified Survey Vendor in addition to satisfactorily reporting PQRS measures via the GPRO Web Interface. CMS will not bear the cost of administering this required survey.
• The group practice must have all CARPS for PQRS survey measures reported on its behalf via a CMS-certified survey vendor. In addition, the group practice must report on all measures included in the GPRO web interface; and populate data fields for the first 248 consecutively ranked and assigned beneficiaries in the order in which they appear in the group's sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 248, then the group practice must report on 100 percent of assigned beneficiaries (MAV will be applied). A group practice will be required to report on at least one measure for which there is Medicare patient data.
• Click here to review the GPRO web interface measures and other resources.

5. Direct Electronic Health Record (EHR) using Certified EHR Technology (CEHRT) (2-99 EPs)
• Report nine measures covering at least three NQS domains. If the group practice’s direct EHR product or EHR data submission vendor product does not contain patient data for at least nine measures covering at least three domains, then the group practice must report the measures for which there is patient data (MAV will be applied). A group practice must report on at least one measure for which there is Medicare patient data.
• If the group practice chooses to report CAHPS for PQRS, the following criteria apply: Must participate via CMS-certified survey vendor to have 12 CAHPS for PQRS survey measures administered to eligible beneficiaries seen during the 12-month reporting period. Must report at least six additional measures, outside of CAHPS for PQRS, covering at least two NQS domains. At least one of these measures must contain Medicare patient data.

6. Direct Electronic Health Record (EHR) using Certified EHR Technology (CEHRT) (100+ EPs)
• The group practice must have all CAHPS for PQRS survey measures reported on its behalf via a CMS- certified survey vendor, and report at least six additional measures, outside of CAHPS for PQRS, covering at least two of the NQS domains using the direct EHR product or EHR data submission vendor product. If less than six measures apply to the group practice, the group practice must report up to five measures (MAV will be applied). Of the additional six measures that must be reported in conjunction with reporting the CAHPS for PQRS survey measures, a group practice would be required to report on at least one measure for which there is Medicare patient data.

 

About CAHPS for PQRS and CMS-Certified Survey Vendor

According to CMS, the CMS-certified survey vendor reporting mechanism is available to all PQRS and Medicare Shared Savings Program ACO group practices to supplement their PQRS reporting with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS surveys. CAHPS for PQRS are patient experience surveys that measure experiences with, and ratings of, health care providers and plans. Complete information about the CAHPS for PQRS survey measures is available on the CAHPS webpage. The data collected on these surveys will be submitted on behalf of the group practice by the CMS-certified survey vendor. The following rules apply to CAHPS:

•    PQRS group practices of 2-24 EPs will have the option to participate via CMS-certified survey vendor in addition to reporting via EHR, qualified registry reporting mechanisms.
•    PQRS group practices of 25-99 EPs have the option to participate via CMS-certified survey vendor in addition to reporting via EHR, qualified registry, or GPRO Web Interface reporting mechanisms.
•    PQRS group practices of 100 or more EPs must participate via CMS-certified survey vendor in addition to another reporting mechanism elected during GPRO registration – EHR, qualified registry, or GPRO Web Interface.

The CAHPS for PQRS survey is equal to three individual measures and one NQS domain.

Note: Shared Savings Program ACOs must participate via CMS-certified survey vendor in addition to reporting quality data through the GPRO Web Interface.

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