Group vs. Individual MIPS Reporting in 2025: A Must-Read FAQ for Multi-Provider Practices | TriumpHealth

For multi-provider practices, choosing between group and individual MIPS reporting is a strategic decision with significant implications for compliance, performance scores, and Medicare reimbursements. This FAQ addresses common questions to help your practice make an informed choice while aligning with MIPS CMS guidelines for optimal results.

Q1: What is the difference between group and individual MIPS reporting?

Individual Reporting: Each clinician reports their own data under their National Provider Identifier (NPI) and Taxpayer Identification Number (TIN). Performance is assessed separately for each clinician, following MIPS Medicare requirements.

Group Reporting: All clinicians under the same TIN report collectively. The group is assessed across all MIPS reporting categories, and all members receive the same payment adjustment based on the group’s performance. This method is particularly effective when leveraging MIPS Consulting services to streamline data collection and measure selection.

Q2: What are the advantages of group reporting?

Reduced Administrative Burden: Group reporting simplifies data submission by consolidating efforts, reducing the workload compared to individual reporting.

Flexibility in Measure Selection: Groups can choose measures that best reflect the strengths of the practice, potentially leading to higher scores, especially when guided by MIPS Consulting experts.

Inclusion of Low-Volume Clinicians: Clinicians who fall below the low-volume threshold individually can still participate and benefit from group reporting.

Consistent Payment Adjustments: All group members receive the same payment adjustment, simplifying financial planning.

Q3: What are the disadvantages of group reporting?

Shared Accountability: The group’s performance reflects on all members, meaning underperformance by some can affect the entire group.

Measure Applicability: Selected measures must be relevant to the group’s services, which can be challenging in multi-specialty practices.

Complex Coordination: Ensuring accurate and timely data collection across the group requires effective coordination.

Q4: What are the advantages of individual reporting?

Personalized Performance Assessment: Clinicians are evaluated based on their own performance, which can be beneficial for high performers.

Tailored Measure Selection: Clinicians can choose measures that align closely with their specialty and patient population, adhering to MIPS CMS guidelines.

Autonomy: Clinicians have control over their reporting and are not affected by the performance of others.

Q5: What are the disadvantages of individual reporting?

Increased Administrative Work: Each clinician is responsible for their own data collection and submission, which can be time-consuming.

Potential for Lower Scores: Clinicians with limited measure options or lower patient volumes may find it challenging to achieve high scores.

Inconsistent Payment Adjustments: Payment adjustments vary by clinician, complicating financial forecasting for the practice.

Q6: How does the choice between group and individual reporting affect multi-provider practices?

For multi-provider practices, group reporting can streamline processes and unify performance metrics, but it requires collective accountability. Individual reporting allows for personalized assessments but increases administrative tasks and may lead to varied payment adjustments among clinicians.

Q7: Can a practice switch between group and individual reporting?

A practice can choose their reporting method each performance year. However, once a method is selected and data is submitted, it cannot be changed for that year.

Q8: How can TriumpHealth assist in making this decision?

TriumpHealth offers expert MIPS Consulting to help practices evaluate the pros and cons of each reporting method, considering factors like practice size, specialties, and performance goals. We provide support in data collection, measure selection, and submission to optimize your MIPS performance while staying compliant with MIPS CMS guidelines.

Need Assistance with MIPS Reporting?

Contact TriumpHealth today to schedule a consultation and determine the best reporting strategy for your practice. To maximize revenue, contact us at 888-747-3836 X0 or email us at [email protected].