Suncoast RHIO Sign Up Form

Health Hub 2024 MIPS Sign-up and Registration Enter your Details Below: (Upon pressing submit, we will create your unique id and you will be contacted by one of our staff). Once you receive a Login ID to our repository, you will be able review and sign all required forms (Consent, BAA) via checkbox agreement, or we can send the forms to you for your records if you prefer. Our 2024 MIPS Listing can be found on the Resource Library link on the bottom of the QPP.CMS.GOV Website, includes prices and service descriptions. Information (currently being updated for 2024) at TotalRevenueCycle.com or www.PricingTermsandDescriptions.com We now offer esMD Audit Transmission Services, Prior Authorization, Consulting. BlockChain and AI coming If you want more information on these offerings, or help with this form, or wish to leave us a phone message, call 1-855-MIPS-EHR or direct at 941-426-6093, email: info@SuncoastRHIO.org Please Enter your Details:

Last Name

First Name

Email ID

Are You the Primary Contact Person

If No, Please enter the Name of Primary Contact Person

Practice/Organization Name

Address Line 1

City

State

Zipcode

Mobile Phone (If this is preferred method to reach you)

Primary Contact Number

FAX Number if Used

Organizational Specialities

{name}

Number Of Clinicians/NPI's Needing Reporting (Sometimes Groups are Preferable over individual reporting. Your consultant will advise)

# Clinicians Needing Dashboard (Not all clinicians in "Groups (TIN) Reporting" Require the Extra Charge Dashboard)

How many TINS you will be Reporting?

Single Rendering NPI over Multiple TIN's (This field tells us if you wish to report for all of your activities if you work and bill separately at multiple locations with different TIN's. If checked, your consultant will discuss)

Signing up for the Year

MIPS or VBP Categories

Audit, esMD or eMDR Transmission (Check this Box only if you have an interest in using Suncoast RHIO CMS HIH Audit Evidence Response Services or Audit Notification Purposes or if you have received an ADR, Our consultant will contact you)

Reporting Type (Note: Hybrid Type applies to NPI's who wish to report as "individual" under some TIN's (If multiple TIN's exist in your practice frontier), and report as "Group" for other TIN's)

Do not submit passwords through Airtable forms. Report malicious form

Alert