Participation In QPP MIPS As An Individual

Merit-based incentive payment systems have a list of eligibility for those thinking of participating in it. Every year, QPP MIPS makes several revisions to its list. For example, the MIPS 2022 list of eligible clinicians have permitted all midwife nurses and social workers to participate. In the same way, MIPS 2023 also has clinician types who can take part. Therefore, the eligible clinicians are asked to submit their MIPS reporting data within the snapshot period. Afterward, CMS will decide their final eligibility and give MIPS scores in the payment adjustment year.

However, there are different participation options for MIPS-eligible clinicians to appear in the QPP MIPS reporting phase. They can either participate as an individual, in groups, in a virtual group, or as an APM entity. To avoid complications, we will only focus on participation in the MIPS program as an individual.

MIPS Participation as an Individual

A single clinician when taking part in MIPS is distinguished as an Individual. They usually have clinician type one from the MIPS-eligible clinician list. These clinicians necessarily have a National Provider Identifier (NPI) associated with a Taxpayer Identification Number (TIN).

Here, National Provider Identifier (NPI) is a 10-digit number that we use as a clinician’s ID. On the other side, a Taxpayer Identification Number (TIN) is another 9-digit numeric code that is useful for Medicare billing. TIN is particularly assigned and issued by the Internal Revenue Service (IRS). The QPP MIPS utilizes it as a unique practice identifier in Medicare claims and data submission.

What Happens during MIPS Reporting as an Individual?

If you are choosing to appear in QPP MIPS individually, then for sure your MIPS final score depends solely on your performance. MIPS program has two snapshots mainly. As an individual, you will have to pick your measures from all four categories. Then, you have to submit the data to CMS. An individual can submit data by selecting any of the available data collection types.

Anyhow, if they choose a MIPS-qualified registry like P3care, they will be able to focus more on their performance. We have been submitting clinicians’ data to CMS for MIPS reporting for many years. So, being experienced, we exactly know the overall process. We are aware of all new and previous updates in the MIPS program. Therefore, we have our preparation for using MVPs in the upcoming years after the transition of MIPS. So what are you waiting for? Come to us for assistance in MIPS reporting this year and for other QPP performance pathways!

Things a MIPS-eligible Individual must Know

Here, we are mentioning some specifications. These might help you when you will be deciding to take part as an individual in QPP MIPS.

  • When You’re a Practice Manager

A practice manager customarily has several clinicians in their practice. In this specific case, you have to check which clinicians in practice fall under the MIPS-eligible clinician types. Then, you have to collect and submit data for every individual MIPS-eligible clinician. Likewise, CMS will give final scores to these individually eligible clinicians only. After that, they will get the payment adjustments during the payment adjustment year.

  • When Working with a Third-Party Intermediary

CMS has assigned an entity with the title of MIPS-qualified registry. These entities majorly act as third-party intermediaries in QPP MIPS just like us. We then help in the data submission process. However, we have many other entities that act as third-party intermediaries. An individual clinician must check whether they are providing the right data for performance evaluation. It is very difficult to find a reliable qualified registry that understands your needs. However, our experience makes us different and reliable for the MIPS reporting program.

  • When You’re APM Participant and MIPS Eligible Simultaneously

If you get entangled in a situation when you are an APM participant already and become MIPS-eligible too, then don’t worry. This situation is the most commonly encountered scenario. Here, CMS left the decision to your choice. An individual is free for reporting either via traditional MIPS or the APM Performance Pathway (APP).

  • When associating your TIN with a Virtual Group

You will obtain the virtual group’s final score if you participate in the virtual group. Any submission by an individual or an APM Entity is deemed voluntary.


That’s all about MIPS participation as an individual. A MIPS-eligible clinician can go for other participation types as well for MIPS reporting. Anyhow, the article provides complete information for those thinking of participating individually. CMS also gives special status to participants if they fulfill certain criteria during data submission. For further queries, you can either leave a comment or come to the chat box directly. Our expert will quickly respond to your queries regarding QPP MIPS.

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