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MIPS 2018: Are you in or out?

Posted By Chet Seward, Friday, April 13, 2018

If you’re still trying to figure out whether you have to report MIPS data for 2018, based upon recent changes by the federal government, then a new online tool can help your decision-making process. The Centers for Medicare & Medicaid Services (CMS) has released an online tool that enables clinicians to determine whether they must participate in the Merit-Based Incentive Payment Program (MIPS) this year. 

Fierce Healthcare reports that “the second year of MIPS quality reporting requirements started January 1, yet physicians were not sure if they were in or out of the program. In fact, given new threshold requirements for the MIPS program in 2018, CMS estimates more than 500,000 clinicians will be excluded from MIPS this year.

In its notice about the 2018 MIPS eligibility tool, CMS makes note of the changes to its low-volume threshold requirements. To reduce the burden on small practices, CMS changed the threshold to exclude clinicians and groups if they:

  • Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule; OR
  • Furnished covered professional services to 200 or fewer Medicare Part B-enrolled beneficiaries

In other words, to be included in MIPS in 2018, clinicians or groups need to have billed more than $90,000 in Medicare Part B allowed charged AND furnished services to more than 200 beneficiaries. (The threshold exempts even more physicians, since in 2017, clinicians had to participate in MIPS if they billed Medicare Part B more than $30,000 a year and saw more than 100 Medicare patients a year.)”

Determine your 2018 MIPS eligibility status today by using the MIPS Participation Lookup Tool.

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