Update: Recheck Your Final 2019 MIPS Eligibility Status

After releasing final 2019 Merit-based Incentive Payment System (MIPS) eligibility data, CMS discovered and corrected inconsistencies in the data. If you checked your eligibility following the December 4th listserv announcing final MIPS eligibility, your status may have been affected by the data inconsistencies. We encourage you to use the QPP Participation Status Tool to re-check and confirm your final 2019 MIPS eligibility.

If you haven’t checked your final MIPS eligibility yet, you should do so now to understand your participation requirements for the 2019 performance period. The 2019 MIPS data submission period opens January 2, 2020 at 10am EST.

Checking Your Final 2019 MIPS Eligibility

Your initial 2019 MIPS eligibility status was based on CMS review of Medicare Part B claims and PECOS data from October 1, 2017, to September 30, 2018. Your final eligibility status is based on our reconciliation of this first review with a second review of Medicare Part B claims and PECOS data, from October 1, 2018, to September 30, 2019.

As a reminder, if, after the first review of your initial eligibility status earlier this year, you were determined to be:

  • Eligible for MIPS at a particular practice: Your eligibility status might have changed, and you may no longer be eligible at this practice.
  • Exempt from MIPS at a particular practice: You will remain exempt.

Please note, if you joined a new practice (meaning you assigned your billing rights to a new or different TIN) and billed Medicare services between October 1, 2018, and September 30, 2019, we evaluated your MIPS eligibility based on your association with that new practice (identified by TIN) exclusively during this second review.

If you joined a new practice after September 30, 2019, 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.

For More Information

Questions?

Contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 AM and after 2 PM ET.

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).