Health Information Compliance Alert

Published on Thu Jun 06, 2013 PDF

If you’re reporting your quality data using the group designation, get familiar with options outlined below:

GPRO Web Interface

The GPRO Web Interface is only available to group practices of 25 or more eligible professionals. Groups electing this option will report on a set of 18 primary care and prevention measures.

Please note that due to the primary care office visit E/M code attribution, no beneficiaries for these measures can be assigned to an emergency department visit. As a result, this option is NOT recommended for emergency department only or hospital-based TINs and will not meet the criteria for the incentive for hospital based group practices, says Dennis Beck, MD, FACEP, President and CEO Beacon Medical Services in Denver, CO.

GPRO Qualified Registry

CMS will offer group practices consisting of two or more eligible professionals the option to report PQRS measures through qualified registries. This is a new reporting option for group practices and actually the only option that smaller group practices (2-24 professionals) can use to qualify as a group for the 2013 PQRS incentive.

GPRO Administrative Claims Option

The new administrative claims option provides groups with an additional opportunity to avoid the 2015 PQRS and VBM penalties. Under this option, CMS will analyze a group’s Medicare claims for a set of 17 measures for assigned beneficiaries, and specific quality data codes do not have to be submitted to CMS.

However, because of the primary care office visit E/M codes used to assign beneficiaries, no beneficiaries will be assigned to emergency department visits. CMS has agreed that for groups who elect this option, even if they have a denominator of zero for all measures, they can still avoid the 2015 PQRS penalty for this option only.

Although participation in the new administrative claims option does NOT earn a PQRS incentive, if a group practice elects to use the administrative claims option, the individual eligible professionals may still use the traditional claims or registry reporting mechanisms to qualify for the 2013 PQRS incentive for this option only, Beck explains.