Clinicians and groups are excluded from MIPS for 2021 if they:
- Billed $90,000 or less in Medicare Part B allowed charges for covered professional services during either of the 2 segments of the MIPS Eligibility Determination Period (October 1, 2019 – September 30, 2020, or October 1, 2020 – September 30, 2021); OR
- Provided care to 200 or fewer Part B-enrolled patients during either of the 2 segments of the MIPS Eligibility Determination Period; OR
- Provided 200 or fewer covered professional services to Part B patients during either of the 2 segments of the MIPS Eligibility Determination Period.
In order to be eligible for MIPS, a clinician or group must exceed all 3 criteria listed above. You can check the Quality Payment Program (QPP) Participation Status Tool to view your final 2021 eligibility status for MIPS.
Participation Options for Clinicians and Groups Not Eligible for MIPS
Clinicians and groups who aren’t eligible for MIPS can still report data via traditional MIPS. Clinicians and groups who are identified as “opt-in eligible” on the QPP Participation Status Tool have exceeded 1 or 2 of the low-volume threshold criteria noted above and have at least one clinician who:
- Is identified as a MIPS eligible clinician type on Medicare Part B claims;
- Enrolled as a Medicare provider before 2021; and
- Isn’t a QP.
Opt-in eligible clinicians and groups who wish to report data via traditional MIPS can:
- Elect to Opt-in to MIPS. You’ll receive a MIPS payment adjustment (positive, negative or neutral).
- Note: Once you make your election, your election is binding and irreversible.
- Voluntarily Report. You won’t receive a MIPS payment adjustment (no election is required to voluntarily report data to MIPS).
Clinicians and groups who are excluded from MIPS and aren’t “opt-in eligible” because they fall below all 3 of the low-volume threshold criteria may choose to voluntarily report data to MIPS but won’t receive a MIPS payment adjustment.
Note: MIPS APM Participants who are “opt-in” eligible also have the option to elect to opt-in and report using the APM Performance Pathway (or APP).
Before reporting data, opt-in eligible clinicians and groups who wish to submit data will need to complete an election to opt-in or voluntarily report in MIPS by signing in to the QPP website. Qualified Registries and Qualified Clinical Data Registries (QCDRs) can also submit elections on behalf of these clinicians and groups. Elections can be made once the 2021 MIPS submission period opens on January 3, 2022.
For More Information
Visit the Reporting Options Overview webpage on the Quality Payment Program website. The 2021 MIPS Opt-In Reporting and Election Process Toolkit will be available on the QPP Resource Library by the start of the submission period.
Please contact the Quality Payment Program at 1-866-288-8292 (Monday-Friday 8 a.m.- 8 p.m. ET) 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.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.