Easy Way to Determine MIPS Participation Status

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.

What is Macra

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.

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. She has more than 20 years experience in print production and content management, and has worked in a variety of capacities for several publications.
Renee Dustman

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Renee Dustman, BS, MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. She has more than 20 years experience in print production and content management, and has worked in a variety of capacities for several publications.

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