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Easy Way to Determine MIPS Participation Status

The Centers for Medicare & Medicaid Services (CMS) has made it easier for clinicians to determine their eligibility in the Merit-based Incentive Payment System (MIPS): A new interactive online tool allows clinicians to determine their status simply by entering their national provider identifier.
Last month, CMS also started sending Medicare-participating clinicians notices in the mail to inform them of their eligibility.

MIPS Eligibility Criteria

To avoid a negative 4 percent payment adjustment to Medicare Part claims in 2019, the following clinicians — who bill Medicare Part B $30,001 or more a year and see 101 or more Medicare patients a year — must submit 2017 performance data:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified nurse practitioners

MIPS Exceptions

These clinicians are exempt, however, if they are:

  • Newly enrolled in Medicare in 2017;
  • See at least 20 percent of their Medicare patients or 25 percent of their Medicare payments through an Advanced Alternate Payment Model; or
  • Bill Medicare $30,000 or less in a year or see 100 or fewer Medicare patients in a year.

Clinicians who are exempt from MIPS need not do anything.

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Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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