For the 2018 MIPS performance period and the 2020 MIPS payment year, CMS will determine if clinicians exceed the low-volume threshold in one of these evaluation periods:
- Historical claims data: September 1, 2016 – August 31, 2017 (1st eligibility determination period)
- Performance period claims data: September 1, 2017 – August 31, 2018 (2nd eligibility determination period)
Clinicians who are determined to be below the low-volume threshold as an individual in the first determination period will stay ineligible at this practice, no matter the volume of your allowed charges or beneficiaries in the second determination period. If included as an individual in the first determination, clinicians may be reclassified as ineligible if they are below the low-volume threshold analysis in the second determination period.
See pages 94 and 95 of the Quality Payment Program Final Rule for more details.