MIPS Tip Tuesday

Did you know that you can participate in MIPS as an individual or as a group?

One of the key decisions you will need to make next year (if you are in the MIPS track of MACRA) is whether you will participate on your own or with your group.

1. Reporting as an individual

If you send MIPS data in as an individual, your payment adjustment will be based on your performance. An individual is defined as a single National Provider Identifier (NPI) tied to a single Taxpayer Identification Number.

Clinicians who choose this path will send their data for each of the MIPS categories through an electronic health record, registry or a qualified clinical data registry. The quality portion of MIPS can also be sent via your Medicare claims.

2. Reporting as a group

If you send your MIPS data with a group, the group will get one payment adjustment based on the group’s performance. CMS defines a group as “a set of clinicians (identified by their NPIs) sharing a common Taxpayer Identification Number, no matter the specialty or practice site.”

Clinicians who choose this path will send in group-level data for each of the MIPS categories through the CMS web interface or an electronic health record, registry or a qualified clinical data registry. To submit data through our CMS web interface, you must register as a group by June 30, 2017.

A clinician’s MIPS composite performance score could be significantly impacted depending upon whether that clinician is rated individually or inherits the final score earned by an entire group. Practice managers will need to assess the best path forward for their group. Will clinicians in your group fare better when their numbers are averaged? Or does it make sense to send everyone’s scores individually?

Luckily, next year is a transition year, and avoiding a penalty will be very easy no matter what route you take. However, in 2018, your decision could influence whether you will get a penalty, remain neutral or score a bonus.

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Diana Strubler, Policy and Standards Senior Manager, joined Acumen in 2010 as an EHR trainer then quickly moved into the role of certification and health IT standards subject matter expert. She has successfully led Acumen through three certifications while also guiding our company and customers through the world of Meaningful Use, ICD-10 and PQRS.