Criteria for Determination of Satisfactory Reporting for Group

70.2 – Criteria for Determination of Satisfactory Reporting for Group Practices and Process for Reporting by Group Practices (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) In accordance with section 1848(m)(3)(C)(i) of the Act, we established, beginning with the 2010 Physician Quality Reporting System, a new process whereby group practices can qualify to earn 32 a Physician Quality Reporting System incentive based on a determination that the practice satisfactorily reports data on Physician Quality Reporting System quality measures. For 2010, group practice is defined under the Physician Quality Reporting System as 200 or more individual eligible professionals. For 2011, group practice is defined under the Physician Quality Reporting System as 2 or more individual eligible professionals and there are two group practice reporting options (GPRO). Group practices with 200 or more eligible professionals participate in the GPRO option named GPRO I, whereas group practices comprised of 2-199 eligible professionals participate in the GPRO option named GPRO II. Effective January 1, 2012, group practice is defined under the Physician Quality Reporting System as 25 or more individual eligible professionals. CMS eliminated the GPRO II classification. As in prior years, realizing the size of a group practice may vary throughout the reporting period, for purposes of determining a group practice’s reporting requirements under the Physician Quality Reporting System, the size of the group is determined at the time the group’s participation in one of the 2012 GPRO options is approved by CMS. However, please note that the group practice must, at all time, have at least the minimum number of eligible professionals required under the definition of group practice (i.e., 25 eligible professionals for 2012) in order to participate in the GPRO. Each group practice selected to participate in the Physician Quality Reporting System GPRO (see §20.3 for discussion of how a group practice can qualify to participate in the Physician Quality Reporting System GPRO) must complete a data collection web-interface that pre- populated with an assigned sample of patients and those patients’ demographic and utilization information. The group practice is required to populate the remaining data fields necessary for capturing quality measure information on each of the consecutively assigned Medicare beneficiaries with respect to services furnished during the relevant Physician Quality Reporting System reporting period. The selected group practices are provided access to the pre-populated web-interface no later than the first quarter of the year following the program year in which the practice is participating in the Physician Quality Reporting System GPRO. For example, if the group practice is participating in the 2011 Physician Quality Reporting System GPRO, the practice would be provided access to the pre-populated web-interface no later than the first quarter of 2012. Upon receiving access to this pre-populated data collection web-interface, the practice must complete the remaining data elements for a specified number of patients and return the completed web-interface to CMS. For purposes of determining whether a group practice satisfactorily submits Physician Quality Reporting System quality measures data for a particular program year, each selected group practice is required to complete this data collection web-interface for a specified number of quality measures. The quality measures are grouped into disease modules plus a series of patient care measures. Data from the January 1st through October 29th NCH file for the program year (10 months) is used by CMS to randomly assign Medicare beneficiaries to each physician group practice TIN. Medicare beneficiaries are retrospectively assigned to the TIN based on a determination by CMS that the group practice provided the plurality of office or other outpatient services to the beneficiary (with a minimum of at least two visits) in the 10-month period. 33 Furthermore, part-year and managed care patients are not considered since CMS would have incomplete claims data for these beneficiaries and group practices may not have had sufficient time to impact the quality of their care. For each disease module or patient care measure, depending on the group’s size, the selected Physician Quality Reporting System GPRO practice must complete the data collection web- interface for the first 218 (for groups comprised of 25-99 eligible professionals) or 411 (for groups comprised of 100+eligible professionals) consecutively assigned and ranked Medicare beneficiaries. Assigned beneficiaries will be limited to those Medicare FFS beneficiaries with Medicare Part B for whom Medicare is the primary payer. If the pool of eligible assigned beneficiaries is less than 218 or 411 for any module/measure, then the group practice must report on 100% (all) of the assigned beneficiaries for that module/measure to satisfactorily participate in the Physician Quality Reporting System GPRO.