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.



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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).