Claims-Based Reporting 2020

Check out the 2020 Part B Claims Reporting Guide (Pages 15 and 20) for an update to 2020 claims reporting. The Centers for Medicare & Medicaid Services (CMS) states that all Part B Claims quality measures are to be reported at the individual clinician level. This update means that eligible clinicians should report their Part B Claims quality measures under their individual NPI rather than an organization NPI.

How do I submit my claims?

Check your claims to make sure that they are submitted under your individual NPI. How does it work?

MIPS Group Reporting

  • Report claims under your individual NPI.
  • Report Improvement Activities and Promoting Interoperability (or get the exceptions) as a group.
  • Medicare will aggregate your claims data into one group quality score.

MIPS Individual Reporting

  • Report claims under your individual NPI.
  • Report Improvement Activities and Promoting Interoperability (or get the exceptions) as an individual.
  • Medicare will assign an individual MIPS score.

How Does Group or Virtual Group Reporting Work for Part B Claims Measures?

Check out page 20 of the Reporting Guide: Part B claims quality measures are always reported at the individual clinician level. If you are reporting as a group or virtual group, we will aggregate the individually reported quality measures into a group or virtual group quality score.

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