• Check Now: Your 2018 MIPS Eligibility Status May Have Changed

    CMS Also Opens Physician Compare Data for Preview Before It Goes Public

    December 05, 2018 09:56 am News Staff – CMS is asking physicians to take a few minutes to review, via the Quality Payment Program (QPP) Participation Status Tool, their eligibility for the 2018 Merit-based Incentive Payment System (MIPS).

    In an email to physicians, the agency noted that physicians' initial 2018 MIPS status may have changed, and some physicians may, in fact, no longer be eligible to participate.

    CMS conducted an initial review of Medicare Part B claims dated Sept. 1, 2016, to Aug. 31, 2017, and updated physicians' status based on a second review from Sept. 1, 2017, to Aug. 31, 2018.

    Several factors, detailed below, may affect an individual's eligibility status.

    If a physician joined a new practice after Aug. 31, 2018, he or she would not be eligible to participate in MIPS as an individual but could receive a MIPS payment adjustment based on the practice group's participation in MIPS.

    Furthermore, a physician's eligibility status could be affected by changes made to the MIPS low-volume threshold in 2018. Specifically, clinicians and groups are now excluded from MIPS if they

    • 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.

    CMS reiterated that an eligible clinician or group must exceed both of the criteria listed above to achieve MIPS eligibility.

    Need more information? Visit the MIPS participation page on the QPP section of the CMS website, contact the program by email or call the QPP service desk at (866) 288-8292.

    In other CMS news, physicians once again have an opportunity to preview QPP performance information before it appears on the Physician Compare profile pages and in the downloadable database.

    The official 30-day preview period for 2017 QPP data opened Nov. 30 and closes Dec. 31 at 8 p.m. ET.

    Questions about the Physician Compare program, public reporting or the 30-day preview period should be emailed to the program.

    Related AAFP News Coverage
    Merit-based Incentive Payment System
    CMS Releases Updated 2018 MIPS Eligibility Tool


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