Definitions.

Accountable care organization

Accountable care organization (ACO) has the same meaning given this term under § 425.20 of this chapter.

Certified registered nurse anesthetist (CRNA)

Certified registered nurse anesthetist (CRNA) has the same meaning given this term under section 1861(bb)(2) of the Act.

Critical access hospital

Critical access hospital has the same meaning given this term under § 400.202 of this chapter.

Electronic health record

Electronic health record (EHR) has the same meaning given this term under § 414.92 of this chapter.

Eligible professional

Eligible professional has the same meaning given this term under section 1848(k)(3)(B) of the Act.

Federally Qualified Health Center

Federally Qualified Health Center has the same meaning given this term under § 405.2401(b) of this chapter.

Group of physicians (Group)

Group of physicians (Group) means a single Taxpayer Identification Number (TIN) with 2 or more eligible professionals, as identified by their individual National Provider Identifier (NPI), who have reassigned their Medicare billing rights to the TIN.

Performance period

Performance period means the calendar year that will be used to assess the quality of care furnished compared to cost.

Performance rate

Performance rate mean the calculated rate for each quality or cost measure such as the percent of times that a particular clinical quality action was reported as being performed, or a particular outcome was attained, for the applicable persons to whom a measure applies as described in the denominator for the measure.

Physician

Physician has the same meaning given this term under section 1861(r) of the Act.

Physician assistant (PA), nurse practitioner (NP), and clinical nurse specialist (CNS)

Physician assistant (PA), nurse practitioner (NP), and clinical nurse specialist (CNS) have the same meanings given these terms under section 1861(aa)(5) of the Act.

Physician Fee Schedule

Physician Fee Schedule has the same meaning given this term under part 410 of this chapter.

Physician Quality Reporting System

Physician Quality Reporting System means the system established under section 1848(k) of the Act.

Risk score

Risk score means the beneficiary risk score derived from the CMS Hierarchical Condition Categories (HCC) model.

Solo practitioner

Solo practitioner means a single Taxpayer Identification Number (TIN) with one eligible professional who is identified by an individual National Provider Identifier (NPI) billing under the TIN.

Taxpayer Identification Number

Taxpayer Identification Number (TIN) has the same meaning given this term under § 425.20 of this chapter.

Value-based payment modifier

Value-based payment modifier means the percentage as determined under § 414.1270 by which amounts paid to a group or solo practitioner under the Medicare Physician Fee Schedule established under section 1848 of the Act are adjusted based upon a comparison of the quality of care furnished to cost as determined by this subpart.