MIPS eligible clinicians (ECs) can choose to be assessed individually identified by their NPI/tax identification number (TIN) or as a group, defined by their TIN. An EC’s final score may be impacted based on whether he or she reported individually or as a group.
ECs and their practices should check their status on the MIPS Participation Status site to determine if they are eligible to report either as individuals or as a group.
Individual: ECs reporting at the individual level will be assessed based upon their National Provider Identifier (NPI)/Tax Identification Number (TIN) combination. Payment adjustments are based on performance across all MIPS categories and will be applied to the individual EC’s Medicare Part B reimbursements in the correlating payment year. If a clinician does not meet the minimum threshold for MIPS they are exempt from reporting MIPS at the individual level. The low volume threshold for individuals is defined as clinicians with less than or equal to $90,000 in allowed charges, less than or equal to 200 Medicare patients and less than 200 covered professional services under the Physician Fee Schedule. Individuals that meet some, but not all, of these criteria can still choose to opt in to MIPS reporting beginning in 2019.
Group: A practice can report as a group when two or more ECs reassign their billing rights to a single TIN. Groups are assessed collectively at the TIN level across all MIPS categories and payment adjustments will be applied across the group. To participate as a group, the group must report data for all clinicians, including those that would have been exempt as individuals. The low volume threshold for groups is defined as practices with less than or equal to $90,000 in allowed charges, less than or equal to 200 Medicare patients and less than 200 covered professional services under the Physician Fee Schedule. Groups that meet some, but not all, of these criteria can choose to opt in to MIPS reporting. If a practice chooses to report via group, then all clinicians in the group must report.