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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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