Learn all about eligibility, participation, quality and reporting requirements.
You must participate in MIPS (unless otherwise exempt) if, in both 12-month segments of the MIPS Determination Period, you:
If you find it difficult to meet the requirements you can apply for an exception: https://qpp.cms.gov/mips/exception-applications
There are 2 exception applications available to clinicians:
The MIPS Extreme and Uncontrollable Circumstances (EUC) Exception application allows you to request reweighting for any or all performance categories if you encounter an extreme and uncontrollable circumstance that’s outside of your control.
A clinician submits their own individual performance data. You can report traditional MIPS, the APM Performance Pathway (APP) if you're a MIPS APM Participant, and/or a MIPS Value Pathway (MVP) as an individual.
A subgroup is a subset of clinicians in a group (at least 2 clinicians) which contains at least one individually eligible MIPS eligible clinician. Subgroup participation is only available for reporting an MVP and requires advance registration. Subgroups can't report traditional MIPS or the APP.
A practice submits performance data on behalf of all clinicians billing under the tax identification number (TIN). If you're MIPS eligible at the group level only, your practice can participate in MIPS as a group but is not required to do so. If your practice chooses to participate as a group, the MIPS eligible clinicians who aren't eligible as individuals will be included in MIPS and receive a payment adjustment. A group can report traditional MIPS, the APP (if the group exceeds the low-volume threshold or is opt-in eligible at the practice level and includes clinicians in a MIPS APM), and/or an MVP.
You can participate in traditional MIPS as a virtual group if you're part of a CMS-approved virtual group. Virtual groups can't report the APP or an MVP.
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Chief Strategy Officer
Dr. Lance Anderson is the Chief Strategy Officer at PECAA, where he is engaged in all aspects of company strategy. He co-founded PECAA in 2007 and helped lead the organization as it grew from a small local Portland study group to a national alliance of independently owned eye care practices. He served as a board member of Rev-360 from 2015 – 2021 and helped oversee the management and successful sale of Revolution EHR, Visionary Partners, and eventually PECAA.
He earned his Doctor of Optometry degree from Pacific University in 1991. He started his own optometry practice in 1993 in Hillsboro, OR, and was able to grow the practice into a busy three-doctor clinic. He retired from clinical care in 2021 and then moved to New York City where he was tasked with helping to integrate PECAA with the HEA buying group. He recently moved to Nashville, TN where he will continue to be actively involved in creating the future vision for PECAA as it is integrated into the VSP family of businesses.
Chief Member Experience Officer
Dr. Justin Manning is the Chief Member Experience Officer at PECAA, where he leads the member experience team, encompassing member education, the Member Business Advisory services, Events, and the Cold Start program. He is the founder and host of the Practice Advantage podcast. Prior to joining PECAA, he founded The Keratoconus and Scleral Lens Institute at Bettner Vision in Colorado Springs, and eyeLeader, a consulting company focused on leadership development, technology in eyecare, and population health.
He has contributed to Review of Optometric Business and has lectured nationally and internationally on specialty contact lenses, design thinking, population health, and the patient experience. He earned his Doctor of Optometry degree from The Ohio State University and completed a residency in Geriatric Optometry at the VA Puget Sound Healthcare System in Tacoma, WA, a Master of Public Health degree at Salus University, and a graduate certificate in Customer Experience from the CU Boulder Leeds School of Business. He is driven to help all independent eye care professionals grow their businesses and enjoy their practices every single day.
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