CMS Announces MIPS Participation Status Letters Coming Out Soon

CMS announced this week, they are currently reviewing claims and notifying practices regarding which clinicians need to take part in the new Merit-based Incentive Payment System (MIPS). MIPS is part of the new Quality Payment Program (QPP) that went into effect January 1, 2017. The new quality program intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for providing quality care to patients. It replaces the Sustainable Growth Rate and streamlines the previous quality payment programs – Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program into one program.

Clinicians should participate in MIPS in the 2017 transition year if they:

  • Bill more than $30,000 in Medicare Part B allowed charges a year and
  • Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year

Other exemptions for participation in 2017 include:

  • Clinicians who are new to Medicare in 2017 do not have to report until 2018
  • Practitioner types not required to report in 2017 will also be exempted

Starting the end of April through May, practices should start receiving letters from their Medicare Administrative Contractor (MAC) that processes their Medicare Part B claims in their region. This letter will tell the participation status of each clinician associated with the Taxpayer Identification Number (TIN) in a practice.

If you need additional information or have questions regarding the new Quality Payment Program, please contact Cheryl Krusch, LPN, CPC, CPMA, COC and ICDCT-CM at