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Individual or Group Participation

Performance Year

Select your performance year.

How to Participate

Participate as an Individual

An individual is defined as a single clinician, identified by their individual 

National Provider Identifier
 (NPI) tied to a single 
Taxpayer Identification Number
 (TIN). You can participate in MIPS as an individual if you are MIPS eligible at the individual level or 
opt-in
 eligible as an individual.

Remember: If you’re MIPS eligible as an individual, you’re required to participate in MIPS

When you participate as an individual, you’ll collect and report measures and activities based on your individual performance. We will assess your performance across all performance categories at the individual level. If you only participate as an individual, your 

payment adjustment
 will be based on your individual final score from the MIPS performance categories.

Things to consider when deciding whether to participate in MIPS as an individual:

  • If you’re a practice manager, you’ll need to collect and submit data for each individual 
    eligible clinician
    ; only the clinicians who are individually eligible will receive a payment adjustment.
  • If you’re working with a 
    third party intermediary
    , you’ll need to make sure that data is submitted at the individual level for each performance category.
  • You can participate as an individual in addition to participating as a group, and/or APM Entity. If you participate as an individual, a group and/or an APM Entity, your payment adjustment will be based on the highest 
    final score
    .
  • If you participate in a virtual group, you'll receive the virtual group's final score. Any individual or APM Entity submission will be considered voluntary.

Participate as a Group

A group is defined as a single TIN with 2 or more clinicians (at least one clinician within the group must be MIPS eligible) as identified by their NPI, who have reassigned their Medicare billing rights to a single TIN. A practice can participate as a group if the practice (TIN) exceeds the 

low-volume threshold
 and is MIPS eligible, or opt-in eligible, at the practice level. There is no requirement for a practice that is eligible as a group to participate as a group.

When you participate as a group, you’ll collect and report measures and activities based on the aggregated performance of the clinicians billing under the TIN. We will assess your performance across all performance categories at the group level. If you only participate as a group, your payment adjustment will be based on your group’s final score from the MIPS performance categories.

Things to consider when deciding whether to participate in MIPS as a group:

  • If a practice chooses not to participate as a group, the MIPS eligible clinicians who exceed the low-volume threshold as individuals will need to participate as individuals or through an APM Entity, if applicable.
  • If a practice chooses to participate as a group, individual clinicians who aren’t required to participate because they do not exceed the low-volume threshold will receive a payment adjustment.
  • If you’re working with a third party intermediary, you’ll need to make sure that data is submitted at the group level for each performance category You can participate as a group in addition to participating an individual; if you participate as an individual and as a group, your payment adjustment will be based on the higher final score.
  • You can participate as a group in addition to participating as an individual, and/or APM Entity. If you participate as as a group, an individual and/or as an APM Entity, your payment adjustment will be based on the highest final score.
    • If you participate in a virtual group, you'll receive the virtual group's final score. Any group or APM Entity submission will be considered voluntary.

Submission Methods

There are multiple ways to report data to CMS. How you choose to report data and which methods are available to you depend on:

  • Whether you’re participating as a group
  • The size of your practice
  • The type of information technology you use
  • The performance category you’re reporting

Individuals, groups, APM Entities and virtual groups should consider which submission method(s) best fits their practice.

Most methods are available to groups, virtual groups, APM Entities and individuals, however, there are 2 exceptions specific to quality reporting:

  • CMS Web Interface
     can only be used by groups and virtual groups of at least 25 clinicians; and ACOs
  • Claims can only be used to report quality measures by those with the 
    small practice
     designation.