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Learn about MVP Data Collection & Submission

MVP Data Collection

You can collect measure and activity data the same way for both traditional MIPS and MVPs. Here’s what you need to know for MVP data collection.

Data Collection Tips

General

For MVPs and traditional MIPS:

  • Think about using a third party like a Qualified Clinical Data Registry (QCDR) or Qualified Registry. These groups can help you figure out MIPS requirements, collect your data, and send it in for you.

For MVPs only:

  • The “Foundational” layer has rules that work for all MVPs. For example, all measures need to complete the Promoting Interoperability performance category no matter which MVP you pick.

For MVPs and traditional MIPS:

  • You need at least 20 denominator eligible instances for each measure you report (you need 4 measures for MVPs). If you don’t hit this number, you get 0/10 points unless you’re a small practice. You might want to report one extra quality measure just in case you don’t reach the minimum.
  • Look at the collection types for your measures to make sure you can handle them.

For MVPs only:

  • Starting in 2025, you don’t have to pick a population health measure when you sign up for MVP. We’ll figure out both population health measures (if you have enough cases) but only count the better score. These measures are part of the foundational layer and don’t count as one of your 4 required quality measures.
  • If we can’t calculate either population health measure, we won’t include them in your score.
  • You can pick an outcomes-based administrative claims measure when you register for MVP as one of your 4 required measures if your MVP has one.
  • If you don’t have enough cases for this measure, you get 0/10 points just like any other required measure.
  • If you’re in a subgroup, only use quality measure data from the doctors in your subgroup.

For MVPs and traditional MIPS:

  • Starting in 2025, improvement activities don’t have different weights.
  • For groups/subgroups, decide which doctors will do your chosen improvement activities. At least half the doctors in your group/subgroup need to do the activities.

For MVPs only:

  • Everyone doing an MVP, including small practices, must complete 1 improvement activity from the ones available in their chosen MVP.

For MVPs and traditional MIPS:

  • Check your special statuses using the QPP Participation Status tool. Some special statuses let you skip this part (small practices automatically skip Promoting Interoperability).
  • A subgroup gets the same special status and reweighting as its main group.

Cost:

For MVPs and traditional MIPS:

  • You don’t have to report any data for cost measures. We collect and calculate this data for you (if you have enough cases).
  • If you don’t have enough cases for any cost measures in your MVP, we’ll make the cost performance category worth 0%.

    Common Question: If you only use Medicare Part B claims measures but your MVP doesn’t have 4 Medicare Part B claims measures, you’ll need to use other ways to collect data or pick a different MVP.

MVP Data Submission

Sending in data for MVPs works almost the same as sending in traditional MIPS data. Here’s what to remember when getting ready to submit your MVP data.

General

For MVPs and traditional MIPS:

  • Log in during the submission time (January through March) to check any data sent in for you. You can’t send in new or fixed data after this time ends.
  • Make sure your data files (like QRDA III or QPP JSON files) are set up correctly. Think about working with a third party intermediary for help if you’re not sure.

For MVPs only:

  • You must sign up to report an MVP and can only send in data for the MVP you signed up for.
  • Your MVP submissions must have the right MVP identifier (MVP ID) and subgroup identifier from when you signed up, if you have one.
  • If you’re doing both traditional MIPS and an MVP, send in complete data (all performance categories) for each one.
  • If your practice participates in different ways (like as a group and subgroup), send in complete data for each way you participate.

For MVPs only:

  • The Eligible Measure Applicability (EMA) process doesn’t work for MVP reporting and won’t reduce how many measures you need. This is different from traditional MIPS.
  • If you’re a small practice reporting quality measures through Medicare Part B claims for an MVP, add the MVP ID to at least one claim during the year.
  • You don’t have to send in any data for population health measures – we collect and calculate this for you.

For MVPs and traditional MIPS:

  • Make sure each activity you pick is finished and written down correctly following the MIPS Data Validation document rules.
  • Keep records for any activity you report for 6 years in case CMS wants to check them.

For MVPs and traditional MIPS:

  • If you qualify for reweighting but send in data anyway, you’ll cancel your reweighting and get scored in this category.
  • Updated: If we get multiple submissions of your Promoting Interoperability data, we’ll calculate a score for each one and use the highest score.

For MVPs and traditional MIPS:

  • You don’t have to send in any data for cost measures. CMS collects and calculates this data for you.