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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About Author

Healthcentric Advisors
As the New England Quality Payment Program Support Center, Healthcentric Advisors assists New England-based physician and other eligible clinical practices to prepare for and participate in the new Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).