Healthmonix Advisor

Reporting MIPS as Individuals or as a Group: Why Not Both?

Posted by Mike Lewis on September 26, 2019
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The Merit-based Incentive Payment System (MIPS) can be rewarding for those who optimize their scores, and devastating for those who fall behind. 2019 is no longer considered a transition year, which means that the program is doing away with much of the leniency that made reporting easier in the past. The financial risk is now as high as 7%, while the performance threshold has increased to 30 points.

As the stakes continue to rise, it’s more important now than ever before that organizations strategize about their MIPS reporting process for 2019 and beyond. And in the course of that effort, one major decision they will need to weigh carefully is whether to report as individuals (at the NPI level) or as a group (at the TIN level).

RELATED: 3 Points To Consider As You Plan Your 2019 MIPS Reporting Strategy

Although we’ve argued before that reporting as a group is the better choice in a surprising number of cases, there are sometimes good reasons not to—for example, if some providers in the organization have a higher total score than their TIN. This is because when providers submit both as a group and as an individual, CMS will adjust their reimbursement based on the higher of the two final scores.

RELATED: MIPS Hacking: Report as a Group to Maximize ROI

“Sure,” you may be thinking, “but that sounds like a lot of extra administrative work.” Actually, it doesn’t have to be. Organizations that use MIPSPRO reporting software, for example, are able to register and report as a group and then split that group into individual NPIs using MIPSPRO’s unique scoring engine. With no extra cost and minimal effort, users can decide at submission to report from MIPSPRO both as a group and as individuals and get credit for whichever score is higher.

2019 is a challenging year for many, but a smart reporting strategy can go a long way in optimizing your time and efforts as well as maximizing your returns. If you have questions about what all this might mean for your organization specifically, don’t hesitate to reach out! You can schedule a meeting here. Or for more general questions about MACRA and MIPS, check out our MIPS Learning Center and Educational Resources.



Topics: PRO Tips, MACRA & MIPS, Healthmonix, Administrative Burden, Hospitals & Health Systems, ROI