Quality Payment Program: Your MIPS Eligibility Status

Open Payments: Review and Dispute Data by December 31

On June 28, CMS published program year 2018 Open Payments data along with updated and newly submitted data from previous program years (2013-2017). This data is available for review and dispute through December 31.

Physicians and teaching hospitals: Review of the data is voluntary but strongly encouraged. Use the Open Payments Search Tool to review publicly available data. If you believe any records attributed to you are inaccurate, you may initiate a dispute and work with the reporting entity to reach a resolution. Note: CMS does not mediate disputes.

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Quality Payment Program: Check Your Final 2019 MIPS Eligibility Status

Your eligibility status may have changed for the Merit-based Incentive Payment System (MIPS). Check the Quality Payment Program Participation Status Tool to view your final 2019 eligibility status:

  • Your initial eligibility status was based on review of Medicare Part B claims and Provider Enrollment, Chain and Ownership System (PECOS) data from October 1, 2017, to September 30, 2018
  • Your status has been updated based on a second review of Medicare Part B claims and PECOS data from October 1, 2018, to September 30, 2019

 

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Quality Payment Program: MIPS Low-Volume Threshold Criteria for 2019

CMS added a third low-volume threshold criterion for determining Merit-based Incentive Payment System (MIPS) eligibility for 2019. Clinicians and groups are excluded from MIPS if they:

  • Billed $90,000 or less in Medicare Part B allowed charges for covered professional services during either of the two determination periods (October 1, 2017 – September 30, 2018, or October 1, 2018 – September 30, 2019)
  • Provided care to 200 or fewer Part B-enrolled patients during either of the two determination periods
  • New for 2019 – Provided 200 or fewer covered professional services under the Physician Fee Schedule during either of the two determination periods

In order to be eligible for MIPS, a clinician or group must exceed all three criteria listed above. Check the Quality Payment Program Participation Status Tool to view your final 2019 eligibility status for MIPS.

Clinicians and groups who are not eligible for MIPS can still choose to report data to MIPS through the opt-in or voluntary reporting options.

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