Does CMS use the CMS Certification Number (CCN) when analyzing data from Critical Access Hospitals (Method II) for Physician Quality Reporting System (PQRS)?
Yes, CMS uses the CCN to 1) determine which providers should be considered an eligible professional (EP) for PQRS, and 2) analyze quality data for those participating in PQRS via the claims-based reporting mechanism. However, analysis to determine the PQRS downward payment adjustment is based on the unique TIN/NPI combination, or TIN for group practices.
To determine eligibility, CMS will analyze claims data based on the individual/rendering National Provider Identifier (NPI)-level within a Tax Identification Number (TIN) for a CCN, or unique CCN/TIN/NPI combination, or at the CCN/TIN-level for group practices participating via the group practice reporting option (GPRO), referred to as PQRS group practices. If a hospital bills Medicare Part B Medicare Physician Fee Schedule (MPFS) via institutional claims, they should review the 2015 List of Eligible Professionals to determine if their providers are eligible for PQRS.
Analyzing Claims Data for Individual EPs
Additionally, the CCN is used to analyze the reporting of quality-data codes (QDCs) for EPs at a Critical Access Hospital participating via the claims-based reporting mechanism. Including the CCN in PQRS analysis allows CMS to group all of the PQRS claims data (QDCs) reported by a specific provider at a specific Critical Access Hospital. PQRS analyzes data at the TIN/NPI level for individuals; therefore, CMS will analyze all claims data for the unique CCN/TIN/NPI combination for individual EPs. For example, if an individual EP renders services at multiple locations under the same TIN/NPI combination and reports PQRS via claims, then CMS will analyze all claims submitted for that unique CCN/TIN/NPI combination to determine whether the individual EP reported satisfactorily across the multiple locations.
The CCN is not used to analyze quality reporting if the Critical Access Hospital (reporting as a PQRS group practice) or the EPs in a Critical Access Hospital (reporting as individuals) report via qualified registry, electronic reporting using an electronic health record (EHR), qualified clinical data registry (QCDR), or GPRO Web Interface.
Individual EPs who report under more than one TIN during the PQRS program year will need to meet the reporting requirements for each TIN under which (s)he worked to avoid the future PQRS negative payment adjustment for each TIN. PQRS group practices will be analyzed at the TIN level; therefore, all EPs under that TIN who bill Part B MPFS will be included in analysis for purposes of the PQRS downward payment adjustment.
If you need assistance determining whether or not you are eligible to participate in PQRS or for help with other PQRS-related questions, please contact the QualityNet Help Desk at
1-866-288-8912 (TTY 1-877-715-6222) via email@example.com. The QualityNet Help Desk is available from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday.