Medicare Incentive Payments for Group-Practice Physicians

Q.  I belong to a group practice, and our claims contain the group practice identification number. How can Medicare analyze my individual Physician Quality Reporting Initiative (PQRI) participation if my ID is not on the claim?

A.  You must indicate your individual National Provider Identifier (NPI) for the quality-data codes as well as for all Medicare services you provide so Medicare can track the quality measures you report and your total allowable charges, on which your PQRI incentive amount is based. Note that your incentive payment is part of a lump sum payment to the group practice for which you work. 

  • For electronically submitted Medicare claims, the group practice NPI goes in the provider billing segment, loop 2010AA, and your individual NPI goes in loop 2420A.
  • For CMS 1500 paper claims, report your NPI on the individual line item.

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Last Updated On

May 13, 2016

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