Criteria for Determination of Satisfactory Reporting of Individual

70.1 – Criteria for Determination of Satisfactory Reporting of Individual Measures and Measures Groups for Individual Eligible Professionals (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) For eligible professionals participating in the Physician Quality Reporting System at the individual eligible professional level, the criteria for satisfactory reporting differ depending on the reporting period an eligible professional chooses to report, the manner in which an eligible professional reports (whether the eligible professional chooses the claims-based, registry-based, or EHR-based reporting mechanism), and whether an eligible professional chooses to report on individual quality measures or on measures groups. For the 2007 Physician Quality Reporting System, there was only 1 reporting option and a single reporting period that an eligible professional could use to attempt to satisfactorily report quality measures. There was no option of reporting on measures groups, or reporting through a qualified registry or qualified EHR. In 2008, with the introduction of registry-based reporting, reporting on measures groups, and alternative reporting periods for the Physician Quality Reporting System, multiple reporting options became available. For the 2008 Physician Quality Reporting System, there were a total of 9 reporting options. For the 2009 Physician Quality Reporting System, 9 reporting options were also available but there were some differences between the 2008 Physician Quality Reporting System reporting options and the 2009 Physician Quality Reporting System reporting options. 22 For the 2010 Physician Quality Reporting System, 11 reporting options are available. For the 2011 Physician Quality Reporting System, there were still 11 reporting options available. However, there are some differences between the 2010 Physician Quality Reporting System reporting options and the 2011 Physician Quality Reporting System reporting options. To qualify for a Physician Quality Reporting System incentive payment for a particular program year, each eligible professional must ensure that he or she meets the criteria for satisfactory reporting for the relevant reporting period, relevant reporting mechanism, and for reporting either individual measures or measures groups, as appropriate. For the 2012 Physician Quality Reporting System, there are a total of 9 reporting options that an individual eligible professional could use to attempt to satisfactorily report quality measures. The change in the number of reporting options from 11 in 2011 to 9 in 2012 is due to the following factors: (1) the elimination of the 6-month reporting period, except for reporting on measures groups via registry and (2) adoption of an additional reporting option for EHR-based reporting that aligns with the criteria for meeting the clinical quality measure objective for achieving meaningful use under the Medicare EHR Incentive Program in 2012. Although there are multiple reporting options for satisfactory reporting, an eligible professional only needs to satisfactorily report under one option for a specific program year to qualify for the incentive payment applicable to a reporting period for the program year. An eligible professional who qualifies for more than one reporting period for a particular program year will receive the incentive payment for the longest reporting period for which the professional qualifies for that program year. Only one incentive payment per program year may be obtained regardless of how many reporting options the eligible professional chooses. For purposes of determining satisfactory reporting, if an eligible professional attempts to submit data for a quality measure or measures group at least once, then the measure or measures group is presumed to be applicable to the eligible professional. Eligible professionals are responsible for selecting the quality measures and/or measures groups that are applicable to their practices.