Medicare Compliance & Reimbursement

If you’re worried that your Merit-Based Incentive Payment System (MIPS) letter might be lost in the mail, there’s now another way to find out if you’re required to report. A new link from CMS allows providers to punch in their National Provider Identification numbers to access the MIPS eligibility portal.

Most Medicare Part B providers now fall under MIPS, the lower-level entry into MACRA’s Quality Payment Program (QPP). As we mentioned in a previous issue, letters are being sent out in batches through May and provide details outlining clinician status (Medicare Compliance and Reimbursement, Vol. 43, No. 9). Many voiced frustration over the lack of information regarding their MIPS status and reporting requirements, but with the new link and guidance, sending 2017 data should be easy.

“If you’re included in MIPS in 2017, you will need to decide whether to report as an individual or with a group,” the QPP fact sheet advises. Those practitioners included under MACRA in 2017 include physicians defined as “doctors of medicine, doctors of osteopathy, osteopathic practitioners, doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine, doctors of optometry,” the MIPS guidance states, as well as chiropractors, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and any group practices that support these clinicians.

You may already have an idea whether or not you qualify for MIPS measures’ reporting. Remember for this first performance year, if you bill Medicare Part B more than $30,000 in payments a year and see more than 100 Medicare Part B-enrolled patients annually, then you will be part of the QPP.

It’s important to verify your status to avoid a 4 percent penalty in 2019 for the data you submit for CY 2017. Due to the reduced measures that came out in the final rule last fall, many providers will be exempt for this first year of MACRA. Here is a go-to checklist of MIPS exemptions from the QPP fact sheet:

• You bill Medicare Part B less than $30,000 annually.
• You see less than 100 Medicare patients a year.
• You are reporting under an Advanced Alternative Payment Model (APM).
• Your specialty is not included on the list of accepted providers.
• You are in your first year of Medicare enrollment.

For more information about the MIPS link and eligibility, visit https://qpp.cms.gov/learn/eligibility.