CMS Releases Tool to Check Your MIPS Eligibility

Source: Emily Hill, PA, AAPM Coding Consultant
Date: April 18, 2018

CMS has recently released its updated MIPS Eligibility Lookup Tool. Enter your NPI number to determine if you need to participate in the MIPS program in 2018. Providers who meet the established low volume threshold do not need to participate.

CMS revised the volume threshold in 2018 to exclude more providers from the requirement to participate. Providers and groups are excluded from MIPS if they:

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

MIPS (Merit-based Incentive Payment System) is a key part of the CMS Quality Payment Program (QPP). The QPP replaces the Sustainable Growth Rate (SGR) formula for maintaining budget neutrality and streamlines prior quality programs (Physician Quality Reporting System, Meaningful Use Criteria, and the Value Based Modifier) into a single program. The intent of the QPP is to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for providing high quality services along with cost savings.

Information on the Quality Payment Program and MIPS can be found at: qpp.cms.gov. The Eligibility Tool can be found at: qpp.cms.gov/participation-lookup.

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