MIPS Eligibility and Exemptions
Who is considered a MIPS eligible clinician?
To check your specific eligibility, use our online MIPS reporting eligibility tool.
Performance Year | Adjustment Year | MIPS Eligible Clinicians | |
|---|---|---|---|
2020 | 2022 |
| |
| |||
2021 | 2023 | Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists | |
Physical/Occupational Therapists, Speech-Language Pathologists, Audiologists, Clinical Psychologists, Dietitians/Nutritional Professionals |
Please note that CMS defines a physician as “a doctor of medicine, doctor of osteopathy (including osteopathic practitioner), doctor of dental surgery, doctor of dental medicine, doctor of podiatric medicine, or doctor of optometry, and, with respect to certain specified treatment, a doctor of chiropractic legally authorized to practice by a state in which he/she performs this function.”
Possible exemptions for MIPS eligible clinicians
Participation in an Advanced Alternative Payment Model (APM)
If an eligible clinician is a part of an Advanced APM, then they are exempt from MIPS reporting. Current examples of APMs are Accountable Care Organizations (ACO), Patient Centered Medical Homes, and bundled payment models.
MACRA Quality Payment Program Low-Volume Threshold
Otherwise eligible clinicians or groups will be exempt from MIPS reporting if they bill ≤ $90,000 or provide care for ≤ 200 Medicare Part B patients.
NOTE: Clinicians that do not meet the LVT may be able to opt-in to report and receive the incentive.
Newly Enrolled in Medicare
If a clinician enrolls in Medicare in the middle of a performance year, they do not have to participate in MIPS reporting that year. For example, if a clinician was to enroll in Medicare on February 6, 2020, they would be exempt for the 2020 performance year (January 1, 2020- December 31, 2020).
Stay up to date with the latest news regarding MACRA and MIPS.
The Healthmonix Advisor is a free weekly news source, connecting you to the latest updates in the value-based care industry.