A group is defined as a single Tax Identification Number (TIN) with two or more Merit-based Incentive Payment System (MIPS) clinicians. A group is required to aggregate their performance data across the TIN in order to have their performance assessed as a group. The group will be assessed across all four MIPS performance categories. One payment adjustment will be received for the group’s performance.
A group electing to submit data at the group level will have its performance assessed and scored across the TIN, which could include items and services furnished by individual clinicians within the TIN who are not required to participate in MIPS. For example, excluded clinicians are part of the group, and therefore, would be considered in the group’s score.
However, the MIPS payment adjustment would apply differently at the group level in relation to each exclusion circumstance. For example, practices participating at the group level that includes new Medicare-enrolled clinicians, or Qualifying Participants (QPs) or Partial QPs, would have the MIPS payment adjustment only apply to the Medicare Part B allowable charges pertaining to the group’s MIPS clinicians. The MIPS payment adjustment would not apply to such clinicians excluded from MIPS based on these two types of exclusions. Any individual (NPI) excluded from MIPS because they are identified as new Medicare-enrolled, QP, or Partial QP would not receive a MIPS payment adjustment, regardless of their MIPS participation.
Group Reporting for MIPS can be submitted through following mechanisms: Claims, Qualified Clinical Data Registry, Registry, Electronic Health Record, CMS Web Interface, or CAHPS. Every practice’s situation is slightly different, so don’t hesitate to reach out to Qsource for assistance on how to comply with MIPS at no cost to you.
Kelly Gooden attended the University of Alabama where she obtained a Bachelor’s Degree. While working at an EHR company, she realized her niche was the Meaningful Use and PQRS portion of the EHR. So after three years, she decided to use her skills to make a bigger difference. Working at AQAF, a partner of Qsource, has allowed her to be more hands-on and focus solely on making a difference in the lives of medical professionals through Quality Improvement. You can reach Kelly at Kelly.Gooden@area-g.hcqis.org.