Clinicians and groups are excluded from the Merit-based Incentive Payment System (MIPS) for 2020 if they:
- Billed $90,000 or less in Medicare Part B allowed charges for covered professional services during either of the 2 determination periods (October 1, 2018 – September 30, 2019 or October 1, 2019 – September 30, 2020); OR
- Provided care to 200 or fewer Part B-enrolled patients during either of the 2 determination periods; OR
- Provided 200 or fewer covered professional services professional services to Part B patients during either of the 2 determination periods.
In order to be eligible for MIPS, a clinician or group must exceed all 3 criteria listed above. You can check the Quality Payment Program (QPP) Participation Status Tool to view your final 2020 eligibility status for MIPS.
Participation Options for Clinicians and Groups Not Eligible for MIPS
Clinicians and groups who are not eligible for MIPS can still choose to report data to MIPS:
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Make an Election to Opt-in or Voluntarily Report: Clinicians and groups who are identified as “opt-in eligible” on the QPP Participation Status Tool have exceeded 1 or 2 of the low-volume threshold criteria noted above and have at least 1 clinician who:
- Is identified as a MIPS eligible clinician type on Medicare Part B claims;
- Enrolled in Medicare before 2020;
- Is not a QP; and
- Is not a participant in one or more MIPS APM entities, all of which are below the low-volume threshold.
These clinicians and groups can make an election to:
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Opt-in to MIPS. You will receive a MIPS payment adjustment (positive, negative or neutral).
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Voluntarily Report. You will not receive a MIPS payment adjustment.
- Note: Once made, your election is binding and irreversible. (No election is required if you don’t want to report data to MIPS.)
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Voluntarily Report (no election required): Clinicians and groups who are excluded from MIPS and are not “opt-in eligible” because they fall below all 3 of the low-volume threshold criteria may choose to voluntarily report data to MIPS and will not receive a MIPS payment adjustment.
Next Steps
Before reporting data, opt-in eligible clinicians and groups will need to complete an election to opt-in or voluntarily report in MIPS by signing in to qpp.cms.gov. Qualified Registries and Qualified Clinician Data Registries (QCDRs) can also submit elections on behalf of clinicians and groups. Elections can be made once the 2020 MIPS submission period opens on January 4, 2021.
For More Information
Questions?
Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292. To receive assistance more quickly, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
You can now visit the Quality Payment Program (QPP) Participation Status Tool and review your final 2020 eligibility status for the Merit-based Incentive Payment System (MIPS).
We’ve updated your eligibility status based on our second review of Medicare Part B claims and PECOS data, from October 1, 2019, to September 30, 2020.
Review Your 2020 Eligibility
Your status may have changed, so we encourage you to use the QPP Participation Status Tool to confirm your final 2020 MIPS eligibility.
If, after the first review earlier this year, you were determined to be:
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Eligible for MIPS: Your eligibility status could have changed, and you may no longer be eligible. You should use the tool to make sure you’re still eligible.
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Not eligible for MIPS at a particular practice: Your eligibility status, based on your association with that particular practice, didn’t change unless you were identified as a participant in a MIPS APM.
Please note, if you joined a new practice (meaning you billed under, or assigned your billing rights to, a new or different TIN) between October 1, 2019, and September 30, 2020, we evaluated your MIPS eligibility based on your association with that new practice (identified by TIN) during this second review.
Clinicians that joined a new practice after September 30, 2020 are not eligible for MIPS as an individual based on your association with that new practice (identified by TIN). However, you may be eligible to receive a MIPS payment adjustment based on your group’s participation, if the new practice you joined chooses to participate in MIPS as a group.
COVID-19 and 2020 Participation: Exception Application Deadline Extension
The COVID-19 pandemic has impacted all clinicians across the United States and territories. However, CMS recognizes that not all practices have been impacted by COVID-19 to the same extent. For the 2020 performance year, CMS will be using our Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency.
If you have any concerns about the effect of the COVID-19 pandemic on your performance data, including cost measures, for the 2020 performance period, submit an application now and be sure to cite COVID-19 as the reason for your application. We’ve extended the deadline to February 1, 2021.
For More Information
Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
You can now use the updated Quality Payment Program Participation Status Tool to check on your initial 2021 eligibility for the Merit-based Incentive Payment System (MIPS).
Just enter your National Provider Identifier, or NPI, to find out whether you need to participate in MIPS during the 2021 performance year.
Low-Volume Threshold Requirements
To be eligible to participate in MIPS in 2021, you must:
- Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS); AND
- Furnish covered professional services to more than 200 Medicare Part B beneficiaries; AND
- Provide more than 200 covered professional services under the PFS.
If you do not exceed all 3 of the above criteria for the 2021 performance year, you are excluded from MIPS. However, you have the opportunity to opt-in to MIPS and receive a payment adjustment if you meet or exceed 1 or 2, but not all, of the low-volume threshold criteria. Alternatively, you may choose to voluntarily report to MIPS and not receive a payment adjustment if you do not meet any of the low-volume threshold criteria or if you meet some, but not all, of the criteria.
Please note, beginning in 2021, the Centers for Medicare & Medicaid Services (CMS) will evaluate the low-volume threshold for MIPS Alternative Payment Model (APM) participants at the individual or group level, just as it does for participants who are not in MIPS APMs. CMS will no longer evaluate APM Entities for the low-volume threshold.
New Participation Option: APM Performance Pathway (APP)
Beginning in 2021 the APM Performance Pathway (APP) is a new reporting framework, complementary to the MIPS Value Pathways (MVP). The APP is available only to participants in MIPS APMs and can be reported by the individual eligible clinician, group, or APM Entity.
Find Out Today
Find out whether you’re eligible for MIPS today. Prepare now to earn a positive payment adjustment in 2023 for your 2021 performance.
Note: The tool will be updated with Qualifying APM Participant (QP) status at a later time. Additionally, we will update the tool in late 2021 to indicate final MIPS eligibility.
For More Information
Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET. We also encourage you to contact us earlier in the year, as response times often increase with heavier demand as the March 31 data submission deadline approaches.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
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