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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 (NPI) tied to a single (TIN).

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

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

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 ; only the clinicians who are individually eligible (or opt-in eligible and elect to opt-in to MIPS) will receive a payment adjustment.
  • A clinician participating as an individual can also participate at the group, subgroup, and/or APM Entity level; clinicians who participate in multiple ways will receive the highest of their final scores.
  • If you’re working with a , you’ll need to make sure data is submitted at the individual level for each performance category.

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. There's no requirement for a practice that is eligible as a group to participate as a group.

When you participate as a group, you collect and report measures and activities based on the aggregated performance of the clinicians billing under the TIN. We’ll 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, as part of a subgroup, 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 don’t exceed the low-volume threshold will receive a payment adjustment based on the group's reporting.
  • Clinicians in a practice that’s participating as a group can also participate at the individual, subgroup and/or APM Entity level; clinicians who participate in multiple ways will receive the highest of their final scores.
  • If you’re working with a third party intermediary, you’ll need to make sure data is submitted at the group level for each performance category.

Participate as a Subgroup 

A subgroup is a subset of a group which contains at least one MIPS eligible clinician and is identified by a combination of the group TIN, subgroup identifier, and each eligible clinician's NPI. The subgroup participation option is only available when reporting a MIPS Value Pathway (MVP). Learn more about MVPs and the subgroup participation option.

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 and groups should consider which submission method(s) best fits their practice.

Most methods are available to all individuals and groups, however, there are exceptions specific to quality reporting:

  • An individual or group must have the small practice special status to report their quality measures through Medicare Part B claims. 
  • Individuals can’t report the CAHPS for MIPS Survey measure; this measure is only available to registered groups that meet sampling requirements.