MIPS Submission - Individual vs Group Opt-In

If you are Merit-based Incentive Payment System (MIPS)-eligible, you can choose to participate as an individual, a group, or both. Please find more information at the Quality Payment Program website: https://qpp.cms.gov/mips/individual-or-group-participation  

 1. Report 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). If you report only as an individual, you'll report measures and activities for the practice(s)/TIN(s) under which you are MIPS-eligible and be assessed across all 4 performance categories* at the individual level. Your payment adjustment will be based on your Final Score derived from the 4 MIPS performance categories*.

2. Report 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. If you report only as a group, you must meet the definition of a group at all times during the performance period and aggregate the group’s performance data across the 4 MIPS performance categories* for a single TIN. Each MIPS-eligible clinician in the group will receive the same payment adjustment based on the group's performance across all 4 MIPS performance categories**.

3. Report as Both an Individual and Group

** Keet anticipates that the majority of our clients will choose this option**

MIPS-eligible clinicians can report data as an individual and as part of a group under the same TIN. In this instance, the clinician will be evaluated across all 4 MIPS performance categories* on their individual performance and on the group’s performance, with a final score calculated for each evaluation. The clinician will receive a payment adjustment based on the higher of the two scores.

*Physical and Occupational Therapists are part of a special status of providers only scored on 2 MIPS performance categories, Quality and Improvement Activities. 
**If a TIN contains providers from a special status as well as non-special status providers the group is not eligible for the automatic reweighting to 2 performance categories and will be scored on all 4 categories.