eligible professional

(8) Incentives for quality reporting (A) Adjustment (i) In general With respect to covered professional services furnished by an eligible professional during each of 2015 through 2018, if the eligible professional does not satisfactorily submit data on quality measures for covered professional services for the quality reporting period for the year (as determined under subsection (m)(3)(A)), the fee schedule amount for such services furnished by such professional during the year (including the fee schedule amount for purposes of determining a payment based on such amount) shall be equal to the applicable percent of the fee schedule amount that would otherwise apply to such services under this subsection (determined after application of paragraphs (3), (5), and (7), but without regard to this paragraph). (ii) Applicable percent For purposes of clause (i), the term “applicable percent” means— (I) for 2015, 98.5 percent; and (II) for 2016, 2017, and 2018, 98 percent. (B) Application (i) Physician reporting system rules Paragraphs (5), (6), and (8) of subsection (k) shall apply for purposes of this paragraph in the same manner as they apply for purposes of such subsection. (ii) Incentive payment validation rules Clauses (ii) and (iii) of subsection (m)(5)(D) shall apply for purposes of this paragraph in a similar manner as they apply for purposes of such subsection. (C) Definitions For purposes of this paragraph: (i) Eligible professional; covered professional services The terms “eligible professional” and “covered professional services” have the meanings given such terms in subsection (k)(3). (ii) Physician reporting system The term “physician reporting system” means the system established under subsection (k). (iii) Quality reporting period The term “quality reporting period” means, with respect to a year, a period specified by the Secretary.

Source

42 USC § 1395w-4(a)(8)


Scoping language

for purposes of this paragraph
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