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Disclaimer
The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
MIPS Eligibility |
Use the participation tool to look up you eligibility status: https://qpp.cms.gov/participation-lookup
MIPS Eligibility as an Individual
In order to be eligible as an individual clinician, the practitioner must:
- Be identified as an eligible clinician type on Medicare Part B claims;
- Have enrolled in Medicare before 2020;
- Not be a Qualify Alternative Payment Model Participant; and
- Exceed the low-volume threshold as an individual.
If you are eligible as an individual, you are required to report.
MIPS Eligible as a Group
In order to be eligible as a group, the group members must:
- All be identified as eligible clinician types on Medicare Part B claims;
- Have enrolled in Medicare before 2020;
- Not be a Qualify Alternative Payment Model Participant; and
- Be associated with a practice which exceeds the low-volume threshold.
If you’re MIPS eligible in your group, you’ll receive a score and payment adjustment based on group reporting when the group reports.
MIPS Eligible Clinician Types
- Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
- Osteopathic practitioners
- Chiropractors
- Physician assistants
- Nurse practitioners
- Clinical nurse specialists
- Certified registered nurse anesthetists
- Physical therapists
- Occupational therapists
- Clinical psychologists
- Qualified speech-language pathologists
- Qualified audiologists
- Registered dietitians or nutrition professionals
Low-Volume Threshold
An individual clinician must participate in MIPS as an individual or group if, in both 12-month segments of the determination period, the clinician:
- Bills for than $90,000 for Part B covered professional services; and
- Treats more than 200 Part B patients; and
- Provides 200 or more covered professional services to Part B patients.
Determination Period for 2020
Eligible clinicians will be required to participate in MIPS if they meet the Low-Volume Threshold in both determination segments.
Segment 1
October 1, 2018 – September 31, 2019
Segment 2
October 1, 2019 – September 31, 2020
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