How to Sign the Data Release Consent Form

Step-by-step instructions for how to sign the 2017 Data Release Consent Form will be updated when the form signing portal is launched in mid-December.

If you signed up to participate in the 2017 Merit-based Incentive Payment System via the Academy’s IRIS^® Registry, you must submit your signed data release consent form by Jan. 15. The IRIS Registry cannot send your MIPS data to the Centers for Medicare & Medicaid Services without a signed data release consent form. The Jan. 15 deadline applies for both manual MIPS reporting (via the IRIS Registry web portal) and automated data extraction from your electronic health records (via the IRIS Registry clinical database).

Important: The Academy will not submit your data to CMS without a signed consent form for the practice (group reporting) or provider (individual clinician reporting).

• The Data Release Consent Forms will be available in the IRIS Registry dashboard in mid-December.
• Only one person per practice needs to sign the form if you are submitting data as a group.
• If your practice is submitting each provider individually, each provider will need to sign their own data release consent form, including part-time and new physicians who are expected to be in the practice in 2019.
• EHR-integrated practices must sign the consent from by Jan. 15 even if their Q4 data is not yet populated in the dashboard. They will have the opportunity to review Q4 data prior to submission.
• IRIS Registry participants also will be required to sign an addendum updating the IRIS Registry participation agreement.
• Ensure the accuracy of the NPI and TIN on the form because this will be submitted to CMS and if it is the incorrect NPI/TIN combination, it will be rejected.

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