Updated tool lets physicians lookup 2018 MIPS eligibility

The Centers for Medicare & Medicaid Services (CMS) has updated its Merit-based Incentive Payment System (MIPS) Eligibility Lookup Tool. This webpage allows physicians and other eligible clinicians (ECs) to use their national provider identifier (NPI) to find out if they are required to report under MIPS for the 2018 performance period. ECs are excluded from the MIPS reporting requirements if they are in their first year of Medicare participation, fall below the low-volume threshold, or qualify for a bonus through an Advanced Alternative Payment Model (AAPM). ECs who are in an AAPM but don’t qualify for a bonus or participate in a MIPS APM are still required to report. However, the lookup tool does not currently reflect 2018 MIPS APM or AAPM information. CMS anticipates having this information as well as a qualifying APM participant lookup tool available later this spring.

CMS has increased the low-volume threshold for the 2018 performance period, which could increase the number of physicians not required to report. ECs must see more than 200 Medicare Part B patients and receive more than $90,000 in Medicare Part B payments annually to be included in MIPS. The low-volume threshold is calculated at both the individual and practice level. If an EC is below as an individual, but their practice is above the threshold and is reporting as a group, the EC will be included in the group’s reporting and receive a payment adjustment based on the group’s reporting. ECs should verify their group’s reporting decision with their administration.

The MIPS Eligibility Tool also informs ECs of any special status designations, such as belonging to a small practice (15 or fewer ECs) or practicing in a rural or health professional shortage area. CMS provides special scoring considerations for ECs practicing in these settings.

As a reminder, ECs must report a full year of quality data for the 2018 performance period. ECs should determine their participation status soon and ensure the necessary data is being collected if they are eligible.

– Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians