The Role of Advanced Practice Providers (APPs) in MIPS Success for GI Practices
In the era of value-based care, Advanced Practice Providers (APPs) play a pivotal role in helping Gastroenterology (GI) practices succeed in the Merit-Based Incentive Payment System (MIPS), a program developed by the Centers for Medicare & Medicaid Services (CMS) to reward providers for delivering high-quality, cost-effective care.
Understanding MIPS Eligibility for APPs
CMS determines eligibility for MIPS based on several criteria, including:
Billings of $90,000 or more in Medicare Part B allowed charges
Providing over 200 covered professional services
Caring for over 200 Medicare Part B patients in a performance year
Advanced Practice Providers such as Nurse Practitioners (NPs), Physician Assistants (PAs), and Clinical Nurse Specialists are evaluated individually.. That means they can report solo and/or be assessed as part of a team under a group Tax Identification Number (TIN). This dual reporting structure creates opportunities for strategic performance management—especially when APPs are high contributors in specific MIPS performance categories. APPs are evaluated for individual eligibility if they bill under their own NPI. They can be both individually and group eligible. If they are not individually eligible they are still included in the group reporting.
The APP Advantage: Impacting Key MIPS Categories
1. Quality Performance
In GI practices, APPs frequently manage routine chronic care, screenings, and follow-ups—all of which tie directly to MIPS quality metrics such as:
Colonoscopy follow-up care
Hepatitis C screening
Preventive health counseling (diet, tobacco, BMI)
Their consistent patient contact allows them to close care gaps and document critical quality-related interventions, improving the group's overall score.
2. Cost Category
One of the most under-leveraged areas where APPs shine is in the Cost category. Many APPs:
Provide follow-up care that prevents ER visits and readmissions
Identify opportunities to reduce redundant imaging or lab tests
Coordinate pre- and post-op instructions that reduce complications
According to the American Gastroenterological Association (AGA), GI practices that integrate APPs into procedure prep, post-procedure education, and care navigation show measurable reductions in total cost of care.
3. Improvement Activities
CMS rewards practices for engaging in activities that improve care processes and outcomes. APPs can champion initiatives like:
Coordinated care planning
Advance care documentation
Patient education programs (IBD, GERD, colorectal cancer prevention)
APPs are often the most accessible providers in a practice—making them excellent leads for patient engagement programs.
4. Promoting Interoperability
This category centers on the use of certified electronic health record (EHR) technology. While APPs may not lead technology efforts, they heavily influence interoperability by:
Consistently entering structured data
Using electronic prescribing tools
Promoting patient portal enrollment
When APPs are trained to navigate EHR tools effectively, their contributions significantly elevate MIPS scoring in this area.
Elevating APPs as MIPS Drivers
For GI practices aiming to thrive in value-based care models, APPs should be viewed as MIPS drivers, not just clinical extenders. Their ongoing relationships with patients, documentation consistency, and cost-conscious care decisions make them central to maximizing reimbursement and reducing penalties.
Practices should consider:
Providing targeted MIPS training to APPs
Assigning APPs to lead care coordination efforts
Including APP metrics in internal quality dashboards
When empowered and informed, APPs help transform compliance into competitive advantage.
For more detailed guidance on aligning your GI team with MIPS performance goals, KRK Value Based Care Consultants is here to help.
Book a performance strategy session at www.krkvbc.com
