You can now check the Quality Payment Program (QPP) Participation Status Tool to view your final 2018 eligibility status for the Merit-based Incentive Payment System (MIPS).

Your initial 2018 MIPS eligibility status was based on CMS review of Medicare Part B claims and PECOS data from September 1, 2016, to August 31, 2017. Now, CMS has updated your eligibility status based on our second review of Medicare Part B claims and PECOS data, from September 1, 2017, to August 31, 2018.

Checking Your 2018 Eligibility

Your status may have changed, so we encourage you to use the QPP Participation Status Tool to confirm your final 2018 MIPS eligibility.

If, after the first review earlier this year, you were determined to be:

  • Eligible for MIPS: Your eligibility status might change, and you may no longer be eligible. You should use the tool to make sure you’re still eligible.
  • Not eligible for MIPS at a particular practice: Your eligibility status, based on your association with that particular practice, will not change.

Please note, if you joined a new practice (meaning you billed under, or assigned your billing rights to, a new or different TIN) between September 1, 2017, and August 31, 2018, we evaluated your MIPS eligibility based on your association with that new practice (identified by TIN) during this second review.

If you joined a new practice after August 31, 2018, you are not eligible for MIPS as an individual based on your association with that new practice (identified by TIN). However, you may be eligible to receive a MIPS payment adjustment based on your group’s participation, if the new practice you joined chooses to participate in MIPS as a group.

Changes to the Low-Volume Threshold in 2018

Remember, CMS increased the low-volume eligibility thresholds for 2018. 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 (September 1, 2016 – August 31, 2017 or September 1, 2017 – August 31, 2018)

OR

Provided covered professional services to 200 or fewer Part B-enrolled patients during either of the two review periods.

In order to be eligible for MIPS, an eligible clinician or group must exceed both criteria listed above.

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