Participation
Eligible clinicians can submit data individually or as part of a group.
Individual MIPS eligible clinicians are identified by a unique TIN and NPI combination.
A group is defined as a single TIN with two or more eligible clinicians (including at least one MIPS eligible clinician) who have reassigned their billing rights to the TIN. Eligible clinicians and MIPS eligible clinicians within a group must aggregate their performance data across the TIN for their performance to be assessed as a group. A group that elects to have its performance assessed as a group will be assessed as a group across all four MIPS performance categories.
MIPS eligible clinicians participating in MIPS APMs have their performance evaluated according to the MIPS APM scoring standard. Under the MIPS APM scoring standard, the quality measures required by the Medicare Shared Savings Program and the Next Generation ACO Model are used to determine a MIPS Quality performance category score and the Quality performance category is weighted at 50% for the 2017 performance year. For all other MIPS APMs, the Quality performance category weight is zero for the 2017 performance year. This fact sheet provides more information about the MIPS APM Scoring Standard.
Timeline
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 under MIPS, 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 |
January 1 |
Feedback from previous performance year |
Summer |
End of performance year |
December 31 |
Data submission deadline |
March 31 of the following year |
Payment adjustment |
2 years after the performance year |
Score and Payment Attribution
An eligible clinician’s data could have been submitted to CMS for evaluation in three different ways: Individual, Group or APM. It is common in radiation oncology for more than one score to be associated with an NPI or even a TIN/NPI combination.
For groups who submitted data using their TIN identifier, the group’s score will be applied to all eligible clinicians that billed under that TIN during the performance period.
An APM score is assigned to all MIPS eligible clinicians participating during the performance period.
If an individual clinician is a participant in a MIPS APM and the group reports to MIPS independently from the APM, then two scores (group and APM) would be associated with the same TIN/NPI. However, only one MIPS score is assigned to each unique TIN/NPI combination to calculate and apply a MIPS payment adjustment for that specific TIN/NPI. If multiple scores are associated with a TIN/NPI combination, the following hierarchy is used to assign one score:
- If an eligible clinician is a participant in a MIPS APM, then the APM score is used instead of any other score.
- If an eligible clinician received more than one APM score, then the highest score will be used.
- If an eligible clinician reported both as an individual and through a group and is not part of an APM, the higher of the two scores will be used.