Look for MIPS Participation Status Letters in May

May 08, 2017 04:03 pm News Staff

Throughout the month of May, family physicians -- as well as certain other eligible clinicians -- will receive letters from their Medicare administrative contractors, better known as MACs , that will provide information about a practice's 2017 participation status in the Merit-based Incentive Payment System (MIPS).

[Close-up of business letter in window envelope]

In the same envelope will be a second document with additional participation information and a list of frequently asked questions.

CMS notified stakeholders about the mailing during a national stakeholder call on April 25 that focused on the Quality Payment Program(qpp.cms.gov); key AAFP staff members participated in that call.

According to Family Practice Management's April 27 Getting Paid Blog post, titled "Are You Participating in MIPS This Year? Watch Your Mailbox," the letters are intended to inform physicians "whether the group and the individuals within the group are exempt from the MIPS reporting requirements."

Blog author Erin Solis, an AAFP regulatory compliance strategist, writes, "CMS uses both historical claims data and data from the performance period to make this determination."

Furthermore, "Participation in MIPS requires clinicians and groups to report data in four performance categories in 2017 in order to avoid a negative payment adjustment in 2019," she writes.

CMS Launches MIPS 'Look Up' Tool

CMS just announced the launch of an online tool(qpp.cms.gov) created to help physicians and other clinicians determine their participation status in the Merit-based Incentive Payment System for 2017.

Once on the site, it's a one-step process; physicians simply enter their 10-digit national provider identifier.

Check now to ascertain your status!

According to a copy of the CMS letter that AAFP News reviewed, practices were identified via their taxpayer identification numbers.

"Starting in 2017, clinicians will participate in the new Quality Payment Program as a group or individually either through the Merit-based Incentive Payment System or participation in an Advanced Alternative Payment Model (APM)," says the letter.

The correspondence informs health care professionals whether they are considered exempt from MIPS, which would be because

  • they are not among the categories of clinicians included in the program in the first year, or
  • they fall below the low-volume threshold criteria that pertain to clinicians who billed Medicare Part B less than $30,000 in allowed charges or provided care to fewer than 100 Medicare Part B patients.

In addition to physicians, the letter spells out the other clinicians eligible to participate in MIPS in 2017; they are physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists -- unless 2017 is their first year of Medicare participation.

The correspondence provides instructions on what steps MIPS participants need to take and reinforces deadlines to help physicians avoid a 4 percent negative payment adjustment for not participating.

It also provides additional details for clinicians who are not participating in MIPS and for those who are participating in an advanced APM.

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