Quality & Practice

Step 2: Decide How to Participate

Choose the option below that best describes how you bill:

Individual Eligible Professional

  • Individual EPs reporting in multiple Tax IDs: PQRS payment adjustment would be applied to each unsuccessful NPI/TIN reporting. Individual EPs can successfully report PQRS under 1 TIN and still have penalty adjustments applied for not successfully reporting under their different TIN.
  • Individual EPs within a group practice that report as individuals: Are free to choose which PQRS measures/measures groups to report and are not required to register to participate as an individual EP.
    • Analysis is based on the individual/rendering NPI – not group NPI.
    • There is potential for some individual EPs in a group practice to successfully report while other EPs in the same group may be subject to penalty.
  • Individual EPs in solo practices: Participating in PQRS as an individual is the only option.

Group Practice

  • Group Practice: Single Tax Identification Number (TIN) with 2 or more individual EPs who have reassigned their billing rights to the TIN.
    • PQRS reporting is analyzed at the group or TIN level rather than individual NPI.
    • Deadline for 2016: Group practices choosing PQRS GPRO must self-nominate/register between April 1, - June 30, 2016 via www.qualitynet.org.
    • A group practice will determine its size based on the number of EPs (NPIs) billing under the TIN at the time of registration: 2- 24 EPs, 25-99 EPs, and 100 or > EPs.
    • During registration, group practices must also indicate their reporting method for the 12-month period.

  • Once a group practice (TIN) registers to participate in the GRPO, this is the only PQRS participation available to the group & all individual EPs who bill Medicare under the group’s TIN for 2016.
    • Groups who register for the 2016 PQRS GPRO will not be able to withdraw its registration.
  • PQRS for Groups (GPROs) are analyzed at the TIN level under the TIN submitted at the time of the final self-nomination/registration.
  • If a group is unsuccessful at preventing a PQRS payment adjustment, all NPIs under the TIN during the unsuccessful reporting period will receive the payment adjustment.