Frequently Asked Questions: QRUR

Q: What should we do if some of the specialties for our EPs are listed incorrectly?

You should update your PECOS records: https://pecos.cms.hhs.gov/pecos/login.do.

Q: The number of EPs in our TIN identified through billing is different from the number identified through PECOS. Why the difference?

This can happen if an EP was registered with your TIN in PECOS as of 10/16/14, but did not bill during that performance period (PECOS identified but not billing identified). It can also happen if the EP billed under your TIN during that performance period, but their PECOS record didn’t show them associated with your TIN as of 10/16/14. 

Please note that in case of a discrepancy, CMS will use the smaller of the two EP counts to determine your TIN size for the Value Modifier.

Q: If a doctor is with TIN A for part of the calendar year, then moves to TIN B for the remainder of the year, what happens to the data associated with that doctor’s NPI billing to the TIN?

Does the data move with the doctor to the new TIN?

No, the data is TIN-NPI specific, so the TIN A data would be relevant for TIN A and the same for TIN B.

Does the data stay with the old TIN until the end of the calendar year?

Yes, the data would be part of TIN A’s PQRS reporting for that calendar year and not for the following year.

How will that be reflected in the MYQRUR, which only covers part of the year?

The provider would be able to obtain QRURs for each TIN-NPI combination by registering for an IACS/EIDM account with each TIN-NPI combination. Each QRUR would reflect the claims billed (and PQRS data submitted) for one TIN-NPI combination, meaning the provider cannot obtain a QRUR that covers more than one TIN affiliation.

If a doctor retires from practice with TIN A, what happens to the data associated with that doctor’s NPI billing to the TIN?

The data would be submitted for the relevant calendar year and not going forward. If the doctor is part of a practice reporting as a GPRO, the practice would have to submit PQRS data on enough EPs to avoid a penalty, so they most likely would still submit data for the retiring doctor.

 

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