In order to meet CMS requirements for QCDR submission, all individuals and groups must complete the Attestation tab in the MIPS Portal. This attestation states that you are authorizing the ACR NRDR QCDR to submit to CMS on behalf of your TINs and/or NPIs.
The attestation consists of the following:
In consideration of participation in the Merit-based Incentive Payment System (MIPS) administered by the U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services ("CMS"), through use of the American College of Radiology (ACR) National Radiology Data Registry Qualified Clinical Data Registry (NRDR QCDR), I agree and attest to the following:
I understand that CMS may publicly disclose performance data for each performance category associated with the MIPS program. Such public disclosure will not include any patient-specific information.
I confirm on behalf of each of the indicated TIN(s) and/or NPI(s) Medicare Part B participation and eligibility for the Merit-based Incentive Payment System (MIPS).
I agree that I will provide documentation to ACR to validate active tax ID (TINs) for which I am submitting MIPS data before the close of the current MIPS performance period.
If ACR determines it necessary to conduct a data audit or validation, I will timely provide to ACR any data or supporting documentation requested for such purposes.
I attest that the data provided to NRDR QCDR is true and accurate to the best of my ability. I understand the data submitted for the indicated TIN(s) and/or NPI(s) may be subject to validation by ACR NRDR, including submission of physical records upon request by CMS.
I am a physician, practice administrator or other individual authorized to act on behalf of the indicated TIN(s) and/or NPI(s), and in that capacity I hereby:
- Certify that I have authority to provide the selection of measures or activities and confirmation of data completeness level
- Authorize the ACR NRDR CMS-Qualified Clinical Data Registry (QCDR) to transfer to the Centers for Medicare & Medicaid Services (CMS) performance data on measures or activities selected and confirmed by me for purposes of participation in the Merit-Based Incentive Payment System (MIPS)
- Certify that I have taken appropriate steps to ensure compliance with all legal requirements applicable to transmission of patient information