Who is considered a MIPS-eligible clinician in 2018?
- Eligible Clinician Types: Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists AND groups that include one or more of these clinicians
- The 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.
- Other Possible Exemptions
- 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, 2018, they would be exempt for the 2018 performance year (January 1, 2018- December 31, 2018).
- Advanced APM Participation: 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.
Note that 2019 individual and group eligibility has not yet been determined by CMS. We will update this participation eligibility lookup tool as soon as eligibility data is available from CMS.
If you’re exempt from MIPS for Performance Year 2018, you are not required to participate. However, you are encouraged to check your participation eligibility status again at the end of 2018 if you’ve made any changes that may change your eligibility status.
Clinicians Participating in Advanced APMs
For Performance Year 2018, if you have a certain percentage of your Part B payments through an Advanced APM or see a certain percentage of your patients through an Advanced APM, you will not have to submit data to MIPS.
During the QPP Performance Year, CMS takes three “snapshots” (on March 31, June 30, and August 31) to see which Advanced APM participants meet the thresholds to become Qualifying APM Participants (QPs).
If you participate in Advanced APMs, but do not meet the threshold, you may become a Partial QP. Partial QPs can choose if they want to participate in MIPS.
Eligibility Review Periods
For Performance Year 2018, your eligibility was reviewed at two different times during the Performance Year.
Eligibility Review Dates
For Performance Year 2018, the first eligibility review was completed in December 2017 by examining claims from September 1, 2016 through August 31, 2017. CMS reviewed Medicare Part B Claims data and PECOS data and will only apply it to PY 2018.
CMS completed the second review in late 2018. They examined Medicare Part B Claims data from September 1, 2017 through August 31, 2018 and PECOS data. If you joined a new practice during this time period, your eligibility under that practice was evaluated during the second review. Check your final status with our online MIPS eligibility tool.