Frequently Asked Questions

Frequently Asked Questions

This section answers frequently asked questions about publicly reported information for doctors and clinicians on the Medicare.gov compare tool and the Provider Data Catalog (PDC).

Please send your feedback and questions to QPP@cms.hhs.gov.

Publicly Reported General and Performance Information

About the Data

The Compare Tool on Medicare.gov and the Provider Data Catalog

Publicly Reported General and Performance Information

What types of information are available for doctors, clinicians, and groups on the Medicare.gov compare tool and the Provider Data Catalog (PDC)? 

The compare tool on Medicare.gov and the PDC include Quality Payment Program (QPP) performance information and other general information for Medicare doctors, clinicians, and groups.

The general information on the Medicare.gov compare tool profile pages includes:

General Information
InformationDoctors and CliniciansGroups
Name✓✓
Addresses and phone numbers✓✓
Medical specialties✓✓
Medicare assignment status✓✓
Board certifications✓ 
Education✓ 
Gender✓ 
Group affiliation✓ 
Hospital affiliation✓ 
Facility affiliation✓ 
Affiliated clinicians ✓
Alternative Payment Model (APM) affiliation✓ 
Accountable Care Organization (ACO) affiliation ✓
Telehealth services✓ 
Utilization (procedure volume) data✓ 

Do all Medicare doctors, clinicians, and groups have profile pages on the Medicare.gov compare tool?

Only doctors, clinicians, and groups who meet the following criteria will have profile pages:

  • Be in approved status in the Provider Enrollment, Chain, and Ownership System (PECOS);
  • Have at least one practice location address in PECOS;
  • Have at least one specialty in PECOS;
  • Have submitted a Medicare claim or be newly enrolled in PECOS within the last 6 months; and
  • Groups must also have a legal business name and at least 2 active Medicare clinicians reassigning their benefits to the group’s Tax Identification Number (TIN).

How is doctor, clinician, and group performance information displayed on profile pages?

Performance information for doctors, clinicians, and groups, if available, is displayed using measure-level star ratings, percent performance scores, and checkmarks. Specific information about how this performance information is publicly reported is found here:

How is Alternative Payment Model (APM) participation and performance information publicly reported on the Medicare.gov compare tool profile pages and the Provider Data Catalog (PDC)?

Information about 2021 APM participation is reported in the following ways:

  • Measure-level performance scores for groups participating in Medicare Shared Savings Program ACOs are displayed on the group profile page through a pop-up modal for a subset of their quality measures submitted via the APM Performance Pathway (APP).
  • Groups that participated in Shared Savings Program ACOs will have an indicator of APM participation on their group profile page.
  • Clinicians and groups will have an indicator of APM participation on their profile pages, if they participated in the selected APMs.
  • Clinicians who participated in an APM and submitted performance information as individual clinicians in 2021 may or may not have individual performance information available on their profile pages.

For more information about APMs and public reporting, download the following documents:

Can doctors, clinicians, and groups preview their performance information before it’s publicly reported on their Medicare.gov compare tool profile pages and in the Provider Data Catalog (PDC)? 

All doctors, clinicians, and groups with performance information targeted for public reporting on the Medicare.gov compare tool profile pages and the PDC will be able to preview their data before it’s published. The Doctors and Clinicians Preview Period is an opportunity for doctors and clinicians to see their performance information before it’s publicly reported. The Doctors and Clinicians Preview Period will be announced via the Care Compare: Doctors and Clinicians listserv and other interested party listservs, as well as the Care Compare: Doctors and Clinicians Initiative page.

Accountable Care Organizations (ACOs) are able to review their annual performance information via their Medicare Shared Savings Program Quality Performance Reports and MIPS Performance Feedback.

About the Data

How often is general and performance information about doctors, clinicians, groups, and Accountable Care Organizations (ACOs) updated on the Medicare.gov compare tool profile pages and the Provider Data Catalog (PDC)?

General information for doctors, clinicians, and groups, such as addresses and phone numbers, is updated twice a month. Their performance information is updated on an annual basis. Performance information for Shared Savings Program ACOs is also updated on an annual basis.

What data sources are used for doctors’, clinicians’, and groups’ profile pages on the Medicare.gov compare tool and the Provider Data Catalog (PDC)?

Performance information for doctors, clinicians, and groups comes from the Quality Payment Program (QPP). General information is primarily from the Provider Enrollment, Chain, and Ownership System (PECOS). Some of the information in PECOS, such as group affiliations and practice locations, is obtained or verified using claims data. Board certification is derived from certification and accrediting organizations, such as the American Board of Medical Specialties, the American Board of Optometry, and the American Board of Wound Medicine and Surgery. For details about all data files currently used in the PDC, refer to the ­­“Provider Data Catalog: Doctors and Clinicians Data Dictionary.”

Is there a downloadable database of all the information currently available on the Medicare.gov compare tool profile pages for doctors, clinicians, and groups?

The Provider Data Catalog (PDC) is currently available on Data.Medicare.gov and contains general and performance information publicly reported on the Medicare.gov compare tool doctor and clinician profile pages. The PDC also includes additional performance information such as final scores and performance category scores, as well as data about facility affiliations and procedures of interest performed by doctors and clinicians. 

What data is currently included in the Provider Data Catalog (PDC)?

There are 7 doctors and clinicians downloadable data files currently available in the PDC. The data files include:

  • Demographic data describing individual doctors and clinicians;
  • Clinician, group, and virtual group Merit-based Incentive Payment System (MIPS) performance information;
  • Clinician overall MIPS final score and performance category score information; and
  • Clinician utilization (procedure volume) data.

For details about the data files, refer to the ­­“Provider Data Catalog: Doctors and Clinicians Data Dictionary.”

How do I update general information about my group or myself?

Much of the information can be updated in the Provider Enrollment, Chain, and Ownership System (PECOS). Once you update PECOS, the changes will be reflected on profile pages and the Provider Data Catalog (PDC) in 2 to 4 months (the amount of time it takes for the information to be verified and processed).

Individual clinicians can update their first and last name, gender, specialty, education, and group affiliation via PECOS. To update board certification and hospital affiliation, please send an email with your name, National Provider Identifier (NPI), and request to QPP@cms.hhs.gov.  

Groups can update their legal business name, affiliated clinicians, and addresses via PECOS. Groups should email QPP@cms.hhs.gov if they would like to have a “Doing Business As” (DBA) name appear on their profile page.

How do I remove personal contact information?

If your personal information, such as phone numbers or addresses, is displaying on your profile page, send an email to QPP@cms.hhs.gov with the correct contact information so we can make a manual edit to your profile page. The manual edit quickly removes this information from the website; however, the manual edits only remain in effect for 6 months. Therefore, you also need to update this information via the Provider Enrollment, Chain, and Ownership System (PECOS) to ensure your personal information won’t repopulate in the future. We recommend you make the update as soon as possible.

The Centers for Medicare & Medicaid Services (CMS) may suppress street addresses in cases where doctors and clinicians provide non-patient facing or telehealth-only services from their homes, or in instances where there’s a safety concern related to their practice location information being publicly available. Doctors and clinicians can either mark the address as a “Home office for administrative/telehealth use only” location in PECOS, which will suppress street address details, or email the Quality Payment Program (QPP) Service Center to suppress the street address and/or phone number. In such cases, CMS maintains city, state, and zip code information so that doctors and clinicians can still be included in searches and have their performance information reported.

Is the telehealth indicator on the Medicare.gov compare tool profile pages for doctors, clinicians, and groups? 

The telehealth indicator is only on applicable individual doctor and clinician profile pages. Currently, it isn’t operationally feasible to accurately publish telehealth information on group profile pages. For more information, please access the "Telehealth Indicator on Medicare Care Compare: Doctors and Clinicians Public Reporting" fact sheet (PDF, 569 KB).

How does the Centers for Medicare & Medicaid Services (CMS) identify telehealth services for the indicator? 

CMS identifies telehealth services using the most recent Place of Service (POS) and claims modifier codes available and appended on paid physician and ancillary service claims at the time the data are refreshed. CMS uses a 6-month lookback period and refreshes the information on clinician profile pages bi-monthly, as technically feasible. For more information, please access the "Telehealth Indicator on Medicare Care Compare: Doctors and Clinicians Public Reporting" fact sheet (PDF, 569 KB).

I provide non-patient-facing or telehealth-based medical care from my home and need to enroll my home as a practice location. How do I prevent my home address and personal phone number from being published on my profile? 

Doctors and clinicians can either mark the address as a “Home office for administrative/telehealth use only” location in the Provider Enrollment, Chain, and Ownership System (PECOS), which will suppress street address details, or email the Quality Payment Program (QPP) Service Center to suppress the street address and/or phone number.

The Compare Tool on Medicare.gov and the Provider Data Catalog

What is the history of public reporting performance information for doctors, clinicians, and groups?

Consistent with the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) first started a phased approach to public reporting on Physician Compare, the predecessor website focused on public reporting for doctors and clinicians, beginning with the 2012 Physician Quality Reporting System (PQRS) performance information. CMS expanded the number and types of performance information available on Physician Compare. The Medicare and Chip Reauthorization Act (MACRA) of 2015 extended this authority. In 2019, the first Quality Payment Program (QPP) performance information (performance year 2017) was publicly reported on Physician Compare. In 2020, CMS transitioned to publicly reporting performance information on the Medicare.gov compare tool and the Provider Data Catalog (PDC). The most current performance information available for doctors, clinicians, groups, and Accountable Care Organizations (ACOs) is the 2021 performance year QPP performance information.

What is the statutory authority for publicly reporting information about Medicare doctors, clinicians, and groups?

Physician Compare and its successor website draw operating authority from Section 10331(a)(1) of the Affordable Care Act (ACA). Under this authority, the Centers for Medicare & Medicaid Services (CMS) developed Physician Compare and initiated a phased approach to public reporting. Section 1848(q)(9)(A) and (D) of the Medicare and Chip Reauthorization Act (MACRA) facilitates the continuation of this phased approach for publicly reporting doctor and clinician performance information.

Section 1848(q)(9)(A) and (D) of the Social Security Act requires CMS to publicly report:

  • Merit-based Incentive Payment System (MIPS) eligible clinicians’ final scores;
  • MIPS eligible clinicians’ performance under each MIPS performance category;
  • Names of eligible clinicians in Advanced Alternative Payment Models (APMs) and, to the extent feasible, the names and performance of such Advanced APMs; and
  • Aggregate information on the MIPS, including the range of final scores and performance category scores for all MIPS eligible clinicians, periodically.
Page Last Modified:
09/10/2024 06:21 PM
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