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.
**Please note, the below is written to depict the special scoring scenario that PT, OT, and SLP providers are subject to which provides them an exemption from the Cost and Promoting Interoperability categories of MIPS.**
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 2 performance categories at the individual level. Your payment adjustment will be based on your Final Score derived from the 2 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. More information about special status exceptions can be found: here
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 2 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 the 2 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 the 2 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.