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What are other criteria establishing MIPS eligibility and/or MIPS ineligibility?
  • First year of Medicare Part B participation: If an eligible clinician is newly enrolled in Medicare in 2018, they are not considered a MIPS eligible clinician. In 2019, they would be considered a MIPS eligible clinician and would need to report to avoid downward payment adjustments.
  • Low patient/volume threshold: If an eligible clinician bills Medicare for ≤ $90,000 OR Provides care for ≤ 200 Medicare Part B patients in a year then they are not considered a MIPS eligible clinician.
  • Certain participants in Advanced APMs: Certain participants in Advanced Alternative Payment Models (APMs) if considered a Qualifying Participant (QP) are not considered MIPS eligible clinicians. Partial QPs will have the option to elect whether or not to report under MIPS, which determines whether or not they will be subject to the MIPS adjustments.

Posted in: Merit-Based Incentive Program (MIPS)