You can now use the updated Quality Payment Program Participation Status Tool to check on your initial 2021 eligibility for the Merit-based Incentive Payment System (MIPS).

Just enter your National Provider Identifier, or NPI, to find out whether you need to participate in MIPS during the 2021 performance year.

Low-Volume Threshold Requirements

To be eligible to participate in MIPS in 2021, you must:

  • Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS); AND
  • Furnish 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 3 of the above criteria for the 2021 performance year, you are excluded from MIPS. However, you have the opportunity to opt-in to MIPS and receive a payment adjustment if you meet or exceed 1 or 2, but not all, of the low-volume threshold criteria. Alternatively, you may choose to voluntarily report to MIPS and not receive a payment adjustment if you do not meet any of the low-volume threshold criteria or if you meet some, but not all, of the criteria.

Please note, beginning in 2021, 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 participants who are not in MIPS APMs. CMS will no longer evaluate APM Entities for the low-volume threshold.

New Participation Option: APM Performance Pathway (APP)

Beginning in 2021 the APM Performance Pathway (APP) is a new reporting framework, complementary to the MIPS Value Pathways (MVP). The APP is available only to participants in MIPS APMs and can be reported by the individual eligible clinician, group, or APM Entity.

Find Out Today

Find out whether you’re eligible for MIPS today. Prepare now to earn a positive payment adjustment in 2023 for your 2021 performance.

Note: The tool will be updated with Qualifying APM Participant (QP) status at a later time. Additionally, we will update the tool in late 2021 to indicate final MIPS eligibility.

For More Information

Questions?

Contact the Quality Payment Program 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. We also encourage you to contact us earlier in the year, as response times often increase with heavier demand as the March 31 data submission deadline approaches.

Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

About Author

Healthcentric Advisors
As the New England Quality Payment Program Support Center, Healthcentric Advisors assists New England-based physician and other eligible clinical practices to prepare for and participate in the new Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).