Check your final 2019 MIPS eligibility status

Physicians can now check their final 2019 eligibility status for the Quality Payment Program (QPP). The QPP Participation Status Tool tells physicians if they are required to report to the Merit-based Incentive Payment System (MIPS) for the 2019 performance year.

Physicians are considered eligible for MIPS if they exceed the low-volume threshold, are not in their first year of Medicare participation, and are not a qualifying alternative payment model (APM) participant. To exceed the low-volume threshold, a physician must:

• Bill more than $90,000 in Part B-covered professional services,
• See more than 200 Part B patients,
• Provide 20 or more covered professional services to Part B patients.

If a physician does not exceed all three thresholds, they are excluded from MIPS. However, physicians who exceed one or two, but not all, can participate in MIPS. Medicare calculates eligibility using Part B claims from two 12-month segments. The first segment included claims from Oct. 1, 2017, to Sept. 30, 2018; the second from October 1, 2018, to September 30, 2019.

Eligibility is calculated at both the individual (TIN/NPI) and group (TIN) levels. If you are excluded as an individual, you may still be required to participate in MIPS if your practice has decided to report as a group, or participates in a virtual group or a MIPS APM. Additionally, if you bill under multiple TINs, you will need to check your eligibility under each TIN/NPI combination.

If you did not exceed the low-volume threshold in the first segment for a given TIN, your status will not change, even if you exceeded the threshold in the second segment. If you exceeded the threshold in segment one, you will be MIPS-eligible if you also exceeded all three criteria in the second segment.

Physicians can check their eligibility by entering their NPI in the QPP Participation Status Tool. Practices can view and download eligibility for all their clinicians by signing into the QPP Portal. Additional information is available on the QPP website. Medicare has also published a 2019 MIPS Participation and Eligibility Fact Sheet and 2019 MIPS Participation and Eligibility User Guide. You can contact the QPP help desk (1-866-288-8292) with questions.

--Erin Solis, Manager, Practice and Payment for the American Academy of Family Physicians

Posted on Dec 11, 2019 by Erin Solis