The Physician Quality Reporting System (previously known as the Physician Quality Reporting
Initiative or PQRI) is a voluntary reporting program that provides a combination of incentive payments
and payment adjustments to identified individual eligible professionals, and group practices, who
satisfactorily report data on quality measures for covered professional services.
Physician Quality Reporting System
The Affordable Care Act makes further changes to the Physician Quality Reporting System, including
the following
1. Authorizing incentive payments until 2014;
2. Requiring payment adjustments beginning in 2015 for eligible professionals who do not
satisfactorily report data on quality measures during the applicable reporting period for the year;
3. Requiring timely feedback to participating eligible professionals;
4. Requiring the establishment of an informal review process through which eligible professionals
may seek a review of the determination that an eligible professional did not satisfactorily submit
data on quality measures for purposes of qualifying for a Physician Quality Reporting System
incentive payment; and
5. Making an additional incentive payment available for those eligible professionals who
satisfactorily report data on quality measures for a year and having that data submitted on their
behalf through a Maintenance of Certification Program and participate in a Maintenance of
Certification Program practice assessment more frequently than is required to qualify for or
maintain board certification status
In addition, beginning in 2010, group practices
In 2012, the definition of Group Practice Reporting Option (GPRO) was extended to include group
practices comprised of a TIN with at least 25 or more eligible professionals. Therefore, effective
beginning January 1, 2012, “group practice” is defined as a TIN with at least 25 eligible professionals
(as identified by NPIs) who have reassigned their billing rights to the TIN. who have reassigned their billing rights to the TIN) can qualify to earn a Physician Quality Reporting System incentive payment based on the determination that the group practice (as a whole) satisfactorily reports Physician Quality Reporting System quality measures data.
In order to participate in the GPRO, group practices are required to complete a self-nomination
process, the specific requirements of which can be found in the Group Practice Reporting Option
section of the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System
located at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/index.html on the CMS website
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