An individual is a clinician identified by their National Provider Identification (NPI) and tied to a single Taxpayer Identification Number (TIN). Individuals collect data and report measures based on their own performance, and their payment adjustment will be based on their final MIPS score.
A group is a single TIN with two or more clinicians – one of whom must be MIPS eligible – as identified by their NPI, who have reassigned their Medicare billing rights to a TIN. A group reports their activities and measures based on the aggregate performance of all the clinicians billing under the TIN.
A virtual group is comprised of two more TINs that elect to form a virtual group. Virtual groups will aggregate their performance data across all TINs to receive their MIPS final score.
An APM entity participates in an Alternative Payment Model (APM) or other payer arrangement through a direct agreement with the Centers for Medicare & Medicaid Services (CMS), other payer, or through state or federal law or regulation. APM entities aggregate their performance for all clinicians for the quality and improvement activities categories. They can submit Promoting Interoperability data at the group or individual level.