Physician Quality Reporting System and the Electronic Prescribing Incentive Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10482 Attachment D - Medicare Beneficiaries Survey and Correspondence	Form and Instruction	New	Available
Form CMS-10482 Attachment C - Interview Topic Guides and Correspondence	Form and Instruction	New	Available
Form CMS-10482 Attachment B7 - Screen Shots	Form and Instruction	New	Available
Form CMS-10482 Attachment B - Eligible Professionals and Practice Administrators Surveys and Correspondence (B1-B5)	Form and Instruction	New	Available
Form CMS-10482 Attachment A - List of Eligible Professionals	Form and Instruction	New	Available
Supporting_Stmt_B_PRA.pdf	Supporting Statement B	Uploaded 2013-11-26	Available
Attachment E_PQRS_Comments_Response.pdf	Supplementary Document	Uploaded 2013-11-26	Available
Attachment F_PQRS_Revisions_to_CMS.pdf	Supplementary Document	Uploaded 2013-11-26	Available
Attachment_B6_Fact_Sheet.pdf	Supplementary Document	Uploaded 2013-11-26	Available
Supporting_Stmt_A_PRA.pdf	Supporting Statement A	Uploaded 2013-11-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209945	Survey of Medicare Beneficiaries	Form and Instruction	New	Attachment D - Medicare Beneficiaries Survey and Correspondence
209944	Survey of Eligible Professionals and Administrators	Form and Instruction	New	Attachment C - Interview Topic Guides and Correspondence
209944	Survey of Eligible Professionals and Administrators	Form and Instruction	New	Attachment B7 - Screen Shots
209944	Survey of Eligible Professionals and Administrators	Form and Instruction	New	Attachment B - Eligible Professionals and Practice Administrators Surveys and Correspondence (B1-B5)
209944	Survey of Eligible Professionals and Administrators	Form and Instruction	New	Attachment A - List of Eligible Professionals

ICR Details

OMB Control No: 0938-1226	ICR Reference No: 201401-0938-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 21023
Title: Physician Quality Reporting System and the Electronic Prescribing Incentive Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/07/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/09/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved
Responses	12,650	0	0
Time Burden (Hours)	3,805	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: An evaluation of the PQRS and the eRx is needed to assess the participation and non-participation of eligible professionals in these programs. The results of this evaluation will help CMS determine how well the PQRS and the eRx are contributing to better affordable health care for Medicare beneficiaries. The PQRS is a voluntary reporting program that provides an incentive payment to eligible professionals who satisfactorily report data on quality measures on their Medicare Part B claims. The eRx is an incentive program that uses a combination of incentive payments and payment adjustments to encourage electronic prescribing. The study will include a sample of eligible professionals and administrators who participate in these programs and a matching sample of eligible professionals and administrators who do not participate; the study will also include a sample of Medicare beneficiaries being served by these professionals.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3002 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 35936	06/14/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 67150	11/08/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Survey of Eligible Professionals and Administrators	CMS-10482, CMS-10482, CMS-10482, CMS-10482	Attachment A - List of Eligible Professionals ,   Attachment B - Eligible Professionals and Practice Administrators Surveys and Correspondence (B1-B5) ,   Attachment B7 - Screen Shots ,   Attachment C - Interview Topic Guides and Correspondence
Survey of Medicare Beneficiaries	CMS-10482	Attachment D - Medicare Beneficiaries Survey and Correspondence

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	12,650	0	0	12,650	0	0
Annual Time Burden (Hours)	3,805	0	0	3,805	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $785,920

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/09/2014

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