Last Updated: Feb 19, 2019
Clinicians and practices can now check their preliminary Merit-based Incentive Payment System (MIPS) status for the 2019 performance year.
You can find your status online via the Quality Payment Program (QPP) Participation Status Tool here and entering your 10-digit National Provider Identification number to view your status by performance year.
The Centers for Medicare and Medicaid Services (CMS) says it determines MIPS eligibility status by reviewing PECOS data and Medicare Part B claims for services provided during the following two 12-months segments, known as MIPS determination periods:
- Oct. 1, 2017 through Sept. 30, 2018. This includes a 30-day claims run out period.
- Oct. 1, 2018 through Sept. 30, 2019. This does not include a claims run out period.
The participation status information currently available reflects the data from Oct. 1, 2017 through Sept. 30, 2018. Later this year, CMS will review data from the MIPS determination period and update the QPP Participation Tool to reflect final 2019 MIPS status.
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.
Clinicians and groups are excluded from MIPS in 2019 if they meet the low-volume threshold in either of the MIPS determination periods noted above. To meet the low-volume threshold criteria, you must:
- Bill $90,000 or less in Medicare Part B allowed charges for covered professional services payable under the Physician Fee Schedule (PFS), OR
- Furnish covered professional services to 200 or fewer Medicare Part B-enrolled beneficiaries, OR
- Provide 200 or fewer covered professional services to Medicare Part B-enrolled beneficiaries.
The 2019 performance year also marks the first time that there is a choice to opt in to MIPS participation. Clinicians and groups can “opt-in” to MIPS if they meet or exceed one or two, but not all, of the low-volume threshold criteria. Those who opt in will be subject to a MIPS payment adjustment in 2021. The decision to opt in may not be retracted.
CMS says that clinicians and groups who are currently identified as eligible must exceed all three elements of the low-volume threshold in the second segment to remain eligible, except in cases in which a clinician or group has opted in to MIPS.
Visit CMS’ Quality Payment Program 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 the 2019 performance year. You’ll find details on opting in to MIPS participation, an increase to the performance threshold, updates to the weighting of performance categories, and more. Get PAMED’s MIPS fact sheet.
You can find all PAMED resources on the 2019 Medicare Physician Fee Schedule at www.pamedsoc.org/MedicarePFS. PAMED members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.