How to check if you are MIPS-eligible in 2018

You can now check the Quality Payment Program (QPP) Participation Status Tool(qpp.cms.gov) to view your final 2018 eligibility status for the Merit-based Incentive Payment System (MIPS). If you are subject to MIPS, your performance in 2018 will affect your Medicare payments in 2020.

The Centers for Medicare & Medicaid Services (CMS) based your initial 2018 MIPS eligibility status on its review of Medicare Part B claims and Provider Enrollment, Chain, and Ownership System (PECOS)(pecos.cms.hhs.gov) data from Sept. 1, 2016, to Aug. 31, 2017. CMS has updated physicians’ eligibility status based on its second review of Medicare Part B claims and PECOS data from Sept. 1, 2017, to Aug. 31, 2018. Your status may have changed, so CMS encourages you to confirm your final 2018 MIPS eligibility. If you were considered exempt from MIPS based on the first determination, you will remain exempt, even if you exceeded the threshold in the second determination. As a reminder, in 2018, you or your group is excluded from MIPS under the low-volume threshold if you:

• billed $90,000 or less in Medicare Part B allowed charges for covered professional services during either of the two determination periods (Sept. 1, 2016, to Aug. 31, 2017, or Sept. 1, 2017, to Aug. 31, 2018); or
• provided covered professional services to 200 or fewer Medicare Part B-enrolled patients during either of these periods.

You may also be excluded from MIPS if you enrolled in Medicare for the first time in 2018 or participate in an Advanced Alternative Payment Model (APM) and are either a Qualifying APM Participant (QP) or Partial QP

If you are MIPS-eligible, CMS has new MIPS resources available online, including:

• 2018 MIPS Specialty Measures Guide for Primary Care(qpp-cm-prod-content.s3.amazonaws.com): Overview of MIPS and a list of measures and activities that may apply.
• 2018 MIPS Cost User Guide(qpp-cm-prod-content.s3.amazonaws.com): Overview of the MIPS Cost performance category, including measures, reporting requirements, and scoring.
• 2018 MIPS Improvement Activities User Guide(qpp-cm-prod-content.s3.amazonaws.com): Overview of the MIPS Improvement Activities performance category, including participation requirements, reporting methods, and scoring.
• 2018 CMS Web Interface Sampling Methodology(qpp-cm-prod-content.s3.amazonaws.com): Overview of the sampling methodology for the 15 clinical quality measures and information on the number of beneficiaries each organization is expected to report on and how those beneficiaries are selected.
• QP Methodology Fact Sheet(qpp-cm-prod-content.s3.amazonaws.com): Overview of how CMS determines who is eligible to be a Qualifying Alternative Payment Model Participant (QP) and Partial QP.

For more information on participating in the QPP in 2018(qpp-cm-prod-content.s3.amazonaws.com), you can check out the Resource Library(qpp.cms.gov) and About MIPS Participation(qpp.cms.gov) webpages on the QPP website(qpp.cms.gov). If you have questions, you can reach out to your local technical assistance organization(qpp.cms.gov) or contact QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222).  

- Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians