The participation options available to you are also informed by your chosen MIPS reporting option(s). Below is a list of the 5 participation options and applicable reporting options:
- Individual: A clinician submits their own individual performance data. You can report traditional MIPS, the APM Performance Pathway (APP) if you're a MIPS APM Participant, and/or a MIPS Value Pathway (MVP) as an individual. Learn more about Individual Participation.
- Group: A practice submits performance data on behalf of all clinicians billing under the tax identification number (TIN). If you're MIPS eligible at the group level only, your practice can participate in MIPS as a group but is not required to do so. If your practice chooses to participate as a group, the MIPS eligible clinicians who aren't eligible as individuals will be included in MIPS and receive a payment adjustment. A group can report traditional MIPS, the APP (if the group exceeds the low-volume threshold or is opt-in eligible at the practice level and includes clinicians in a MIPS APM), and/or an MVP. Learn more about Group Participation.
- Virtual Group: You can participate in traditional MIPS as a virtual group if you're part of a CMS-approved virtual group. Virtual groups can't report the APP or an MVP. Learn more about Virtual Group Participation.
- Subgroup: A subgroup is a subset of clinicians in a group (at least 2 clinicians) which contains at least one individually eligible MIPS eligible clinician. Subgroup participation is only available for reporting an MVP and requires advance registration. Subgroups can't report traditional MIPS or the APP. Learn more about the MVP reporting option.
- APM Entity: If you're MIPS eligible as an individual and/or group and are a MIPS APM participant, you can participate in MIPS as an APM Entity. An APM Entity can report traditional MIPS, the APP, and/or an MVP. Learn more about APM Entity Participation.
As with previous Medicare programs, there is a program cycle consisting of performance measurement, feedback and payments adjustments.
Performance period and submission:
To potentially earn a positive payment adjustment, physicians or groups collect and send in data on care provided during the performance year. The specific data will vary depending on the specific model.
|Beginning of performance year
|Feedback from previous performance year
|End of performance year
|Data submission deadline
||March 31 of the following year
||Two years after the performance year
It's possible to participate in MIPS in multiple ways. If a clinician (identified by a single unique TIN/NPI combination) has more than one MIPS final score, here’s how we’ll determine which final score and payment adjustment you’ll receive:
- If you participate as a virtual group, you’ll receive a payment adjustment based on the virtual group’s final score, even if you have additional final scores from other participation options.
- If you participate as an individual, group, and/or an APM Entity, you’ll receive a payment adjustment based on the highest available score.