Following is some additional information on how individuals and groups are defined to help you decide whether you want to opt-in as an individual, group, or both. You can find more information at the Quality Payment Program website: https://qpp.cms.gov/mips/individual-or-group-participation.
Report as an Individual
An individual is defined as a single clinician, identified by their 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 the 4 performance categories at the individual level. Your payment adjustment will be based on your Final Score derived from the 4 MIPS performance categories.
Note: If you choose to submit data individually, you are required to submit at least 20 cases per measure to qualify for performance measure scoring.
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. Please note If you report as a group, all eligible clinician's data under the TIN must be reported. There is not an option to pick and choose which providers you report on in a group submission.
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.
Additional note: MIPS Eligible Physical Therapists & Occupational Therapists will automatically have their categories reweighted to only score against Quality & Improvement activities. More information about special status exceptions can be found: here