• What you need to know about MIPS eligibility for 2021

    As you wrap up the Merit-based Incentive Payment System (MIPS) 2020 performance year, here are some important things to remember about MIPS eligibility for performance year 2021.

    You can use the updated Quality Payment Program (QPP) Participation Status Tool to check your initial eligibility. Just enter your National Provider Identifier, or NPI, to find out whether you need to participate in MIPS during the 2021 performance year.

    To be eligible, you must:

    • Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS); AND

    • Provide covered professional services to more than 200 Medicare Part B beneficiaries; AND

    • Provide more than 200 covered professional services under the PFS.

    If you do not exceed all three of the above “low volume threshold” criteria for the 2021 performance year, you are excluded from MIPS requirements. But you can opt in to MIPS and still receive a payment adjustment if you meet or exceed one or two of them. You may also choose to voluntarily report to MIPS and not receive a payment adjustment if you do not meet any of them.

    Beginning this year, the Centers for Medicare & Medicaid Services (CMS) will evaluate the low-volume threshold for MIPS Alternative Payment Model (APM) participants at the individual or group level, just as it does for non-APM MIPS participants. But CMS will no longer evaluate APM Entities (which are different than individuals or groups) for the low-volume threshold.

    To learn more, including MIPS measure specifications, you can visit the QPP website and view the How MIPS Eligibility is Determined page and the 2021 MIPS Eligibility Decision Tree. You can also contact the QPP at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov To receive assistance more quickly, consider calling during non-peak hours (before 10 a.m. and after 2 p.m. ET). Individuals who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

    — Kent Moore, Senior Strategist for Physician Payment, American Academy of Family Physicians

    Posted on Jan 29, 2021 by Kent Moore

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.