Questions about Your MIPS Participation Status?

UPDATED MAY 18, 2017 — The Centers for Medicare & Medicaid Services announced all physicians required to participate in the Merit-based Incentive Payment System will receive notification of their participation status by the end of May. With the program already underway, status letters are considered by many to be long overdue.

CMS recently sent letters to 806,879 clinicians informing them they will not be evaluated under MACRA’s MIPS System for this year, according to a recent article in Modern Healthcare. Exempted doctors are those with less than $30,000 in Medicare charges and fewer than 100 unique Medicare patients per year. Physicians new to Medicare this year are also exempt. About 418,000 physicians will still need to submit MIPS data. The change came after the CMS used an updated formula to estimate providers’ Medicare revenue.

Physicians should soon receive a letter from your Medicare Administrative Contractor that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with your Taxpayer Identification Number (TIN).

Physicians should participate in MIPS in the 2017 transition year if they:

• Bill more than $30,000 in Medicare Part B allowed charges a year and
• Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year

Starting in 2017, physicians can choose to participate in the new Quality Payment Program as a group or individually either through the MIPS or by participation in an Advanced Alternative Payment Model (APM). Physicians can earn a positive MIPS payment adjustment for 2019 if they submit 2017 data by March 31, 2018. Those who don’t submit the required data will receive a negative 4 percent payment adjustment. For more information, visit the Quality Payment Program online.

Physicians can now use an interactive tool on the Quality Payment Program website to determine if they should participate in 2017. To determine your status, enter your National Provider Identifier into the entry field on the tool and find out whether or not you should participate in MIPS this year and where to find resources. To get the latest information, visit the Quality Payment Program website. Contact the Quality Payment Program Service Center at 866-288-8292 (TTY 877-715- 6222) or email QPP@cms.hhs.gov.