Last Updated: Jan 15, 2020
Clinicians and practices can now check their preliminary Merit-based Incentive Payment System (MIPS) status for the 2020 performance year.
Find your status online via the Quality Payment Program (QPP) Participation Status Tool here and entering your 10-digit National Provider Identification number.
Keep in mind that the Participation Status Tool reflects initial MIPS eligibility. By the end of the year, the Centers for Medicare and Medicaid Services (CMS) will update eligibility data to reflect final 2020 MIPS status. In addition, CMS plans to update the Tool to reflect status information for Qualified Advanced Alternative Payment Model participants later in 2020.
MIPS Eligibility: Who Is Excluded and Who Can Choose to Opt In?
Eligible clinicians enrolled in Medicare for the first time during the performance year and clinicians who are significantly participating in an Advanced Alternative Payment Model (Advanced APM) are not required to participate in MIPS reporting.
To meet the low-volume threshold criteria for 2020 MIPS participation, you must:
- Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS); and
- Furnish covered professional services to more than 200 Medicare Part B beneficiaries; and
- Provide more than 200 covered professional services under the PFS.
If you do not exceed all three of the criteria listed above, you are excluded from MIPS.
For the 2020 performance year, clinicians and groups can also either opt-in or report to MIPS if they do not exceed the three low-threshold criteria:
- Opt In to Receive a Payment Adjustment – Clinicians and groups can opt-in to MIPS and receive a payment adjustment in 2022 if they exceed one or two, but not all, of the low-volume threshold criteria. The decision to opt in may not be retracted.
- Voluntary Report to MIPS Without Receiving a Payment Adjustment – Clinicians and groups who do not meet any low-volume threshold criteria or who meet some but not all the criteria can choose to voluntarily report to MIPS. Clinicians will receive performance feedback which would be helpful in preparation for future years. Additionally, you would be eligible to have your data published on Physician Compare.
Visit CMS’ QPP website at qpp.cms.gov for details and resources on both tracks of the QPP – MIPS and Advanced APMs.
The Pennsylvania Medical Society (PAMED) offers a Quick Consult fact sheet to help physicians and practices navigate MIPS in 2020. You’ll find details on eligible clinicians, payment adjustments, a performance threshold increase, and more. Get MIPS fact sheet.
PAMED members with questions can also contact our Knowledge Center at (855) 726-3348 or KnowledgeCenter@pamedsoc.org.