The Ultimate MIPS 2023 Participation Guide; MIPS Reporting

MIPS reporting is an important aspect of healthcare organizations as it helps to ensure compliance with Medicare regulations and helps to maximize reimbursement. Our platform is designed to empower organizations to make informed decisions with real-time reporting.

What is MIPS?

The MIPS is a Merit-based incentive payment system established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It came into effect on January 1, 2017. It is a major catalyst toward transforming the healthcare industry for the year 2023 from fee-for-service to pay-for-value. Healthcare practitioners try far along to find the most precise answer to the following question, i.e., what does MIPS stand for? The MIPS stands for Merit-based incentive payment system and is a program that will determine Medicare payment adjustment. And Eligible clinicians (ECs) may receive a payment penalty, a payment bonus, or no payment adjustment based on their composite performance score.

MIPS assesses your performance across various criteria that contribute to better quality and value in our healthcare system.

MIPS Participation Options

Eligible clinicians may engage in MIPS as individuals, group practices, or APM Entities. In general, doctors who report as specialist Individuals (i.e., clinicians with a single NPI tied to a TIN) will have their payments adjusted based solely on their performance.  Whereas, clinicians reporting as part of a group (i.e., defined as a group of clinicians identified by their NPI who share a common TIN regardless of specialty or practice site) will have their payments adjusted based on the group’s performance across all four MIPS Reporting categories. 

If both an individual and a group score apply to a particular TIN/NPI combination, CMS will choose the higher score to calculate the payment adjustment for that TIN/NPI combination. Similarly, physicians who report at the APM Entity level will be assessed and scored at that level until they obtain a higher final score through individual or group practice participation. It should be noted that certain APMs are known as MIPS APMs, and their participants, if not excluded from MIPS owing to QP status, may be eligible for certain MIPS scoring benefits.

Clinicians can also participate as a “virtual group,” which is made up of two or more TINs made up of solo practitioners and groups of ten or less qualified clinicians who get together digitally (regardless of specialization or location) to engage in MIPS for a year.

Mechanisms for Reporting

Clinicians may also opt to collect and submit data through a variety of channels, such as claims (restricted to physicians in small practices), registries, certified electronic health records (EHR), and web-based attestation (via the QPP Portal). Although the majority of clinicians use a single reporting mechanism, clinicians may use different mechanisms across performance categories (e.g., report quality measures via claims and improvement activities via registry) and within performance categories (e.g., report quality measure A via claims and quality measure B via registry). 

A list of Qualified Registries (QRs) and Qualified Clinical Data Registries (QCDRs) approved for 2023 will be posted to CMS’ QPP Resource Library for members seeking to collect data through a registry. Note that QCDRs differ from QRs in that they offer unique and more specialized quality measures not offered through the traditional MIPS measure inventory. Clinicians can check the Certified Health IT Product List to see whether their EHR is certified or not. However, they should also contact the vendor directly to validate MIPS reporting capabilities.

MIPS Reporting

Reporting is the most crucial step of MIPS; it will finally decide your fate whether to get reimbursed or pay the penalty after the set period of CMS. A MIPS consultant is the only viable source who can help you in this regard. These days, practitioners are usually searching for answers to the following two questions, i.e., what is MIPS reporting 2023 and MIPS reporting 2022 score? In 2023, the agency set a minimum performance criterion of 75 MIPS points (up from 60 MIPS points in 2021), which is the mean final score from the previous performance year. To avoid a MIPS penalty next year, doctors must attain a final MIPS score of at least 75 points.

Physicians can choose whether to participate in MIPS as an individual or as a group under the Quality Payment Program (QPP). When it comes to MIPS reporting, this is one of a practice’s first decisions.

The impact of this decision affects the performance of each “EC” (Eligible Clinician) reporting under a “TIN” and, ultimately, the potential to receive an incentive.

When selecting a MIPS reporting option, either individual or group, the choice has been made for all three categories.

What is MIPS and MIPS reporting
What is MIPS and MIPS reporting

Top Motivation to Hire NEO MD Billers and MIPS Consultants

NEO MD stood best among competitors’ Revenue Cycle Management Companies due to the following cores;

  • Delivering Certified MIPS Consultancy with a 40% Client incentivized ratio 
  • Our experts work hard to reduce your front-end denials by 20%.
  • Claim first level acceptance ratio; 95-97%
  • Refunds adjustment and Payment posting to improve the cash flow.
  • Offer Provider & Staff Productivity Analysis
  • Offering state-of-the-art medical billing services for small practices, medium-sized, and large ones.
  • Offer internal Medical Billing audits to uncover loopholes
  • Improve RCM system efficiency with a robust credentialing team. 
  • Provide fortnightly financial and practice overviews 
  • Deliver customized Revenue Cycle Management Services to unearth operation shortcomings.
  • Provide in-depth MIPS Healthcare Reporting services that are of high quality and error-free.

Individual MIPS Reporting

According to CMS, an individual is described as a single clinician, identified by a single “NPI” (National Provider Identifier number) tied to a single TIN (Taxpayer identification number). If you are an Eligible Clinician and choose MIPS reporting individually, your Final Score will determine your performance alone. 

If you are reporting the three performance categories individually, you’ll need to find quality measures and improvement activities for each practice’s provider. To qualify for points in the category of “Promoting Interoperability,” each provider must pass the base score measures independently.

While reporting as an individual provides you complete control over performance, and payment adjustments, collecting data for your ECs individually might result in a significant administrative burden. 

Group MIPS Reporting

CMS states that a group consists of a single Taxpayer identification number (TIN) (with two or more EC (Having at least one MIPS-eligible clinician), as identified by their NPI (National Provider Identifier), who have reassigned their Medicare billing privileges to the TIN.

The group reporting procedure allows a group of providers to submit their data and have it assessed collectively, which means that each physician in the group will receive the same MIPS Final Score and payment adjustment (even ECs who weren’t in the group during the performance year).

In general, group scoring treats all of the ECs in the group as if they were one individual.

In most circumstances, group reporting reduces the amount of effort required. It may also be the only technically feasible approach for large organizations.

Quality MIPS Reporting

Instead of selecting measurements for each provider in the group, you choose measures based on the total number of patients treated by the practice. The restrictions do not have to apply to everyone in the group.

In a multi-specialty group, you can select measures that the group performs well on, even if some providers perform poorly or are not eligible for the chosen measures. When you have a large number of specialists in your practice, this makes a significant impact.

The number of patients seen in the practice determines the measure’s qualifying instances, irrespective of which NPI or how many NPIs saw that patient.

What are the CEHRT (Certified Electronic Health Record Technology) requirements for the fiscal year 2023?

Clinicians must use technology certified to the 2015 Edition Cures Update certification criteria for the Promoting Interoperability performance category and report electronic clinical quality measures (eCQMs) for the quality performance category, as previously finalized in the CY 2021 PFS Final Rule (85 FR 84818).

For instance, Measure 226 requires you to question patients about tobacco use at least once in the two years leading up to the performance year’s eligible visit date. In the performance year, if a patient sees provider A, the patient is in the denominator for the entire group. Provider B will earn “credit” for the quality action if the patient has asked about tobacco usage at a previous year’s visit.

Suppose provider B also saw the patient throughout the performance year. In that case, the patient is only reported ONCE for the group, and the group is given credit for the patient’s quality action.

CMS (Centers for Medicare & Medicaid Services) will calculate the All-Cause Hospital Readmission Measure automatically for any group of 16 or more providers with more than 200 eligible instances, and it will contribute toward their Quality score. The following measure does not apply to individual providers.

The Quality category of MIPS 2023 is accountable for 30% of your total MIPS score.

MIPS reporting regulations apply to all specialties in a similar way. That’s why, regardless of their EHR and PM platforms, NEO MD CMS Certified MIPS consultants work with all sorts of practices to help them provide the best MIPS Reporting for the year 2022. 

For MIPS consulting services, you can contact us at ( or (929) 502-3636

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