Healthmonix Advisor

Three Ways to Check Your MIPS Participation Eligibility Status

Posted by Lauren Patrick on July 28, 2017

O6UZR60.jpgWhen we asked MIPS eligible clinicians about their experiences transitioning from PQRS this year, one of the biggest takeaways was that quality matters even more under MIPS than it did under PQRS. Clinicians who want to maximize their reimbursement would consequently be very smart to start reporting as early as possible, and to adjust performance to maximize quality, rather than waiting until the end of the year. If you’re not sure whether or not you are a MIPS-eligible clinician, take advantage of one of the following resources for determining your MIPS participation status as soon as possible so that you don’t get left behind.

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1.pngCheck for a letter from CMS.

CMS sent out letters informing physicians of their MIPS participation status for this year. If you are a physician reporting under a group tax identification number (TIN), be aware you may have missed your notification because the letters were sent to TIN-linked addresses rather than addresses connected to individual National Provider Identifier numbers (NPIs).


2.pngCheck your participation status with this nifty online tool.

Healthmonix now has an online MIPS eligibility lookup tool to get an initial eligibility status for providers.  You can check one, or all, of your providers in one eligibility lookup and receive an overview of MIPS eligibility.   CMS recently released an online tool that lets physicians enter their National Provider Identifier (NPI) to find out their MIPS participation status. Physicians who may otherwise have been exempt individually will still be included in MIPS if their tax identification number (TIN) decides to report as a group.


3.pngCheck the QPP website’s page on MIPS eligibility rules.

If you still need further clarification on your status, the QPP website provides this very helpful page outlining MIPS eligibility rules. The page also includes information about clinicians participating in Advanced APMs, as well as participation that should be considered special status under the QPP.

If you are participating in an Alternative Payment Model (APM), talk to your Center for Medicare & Medicaid Innovation (CMMI) team or leaders managing your participation. The QPP website can help you find this information if you contact them at or 1-866-288-8292.


What Next?

If you determine that you are a MIPS-eligible clinician but aren’t sure how to proceed, start with this free MIPS Survival eBook from Healthmonix, in which we give you an order of operations to follow to ensure MIPS survival. And if you really want to be a MIPS master, subscribe to our blog for free, weekly insights and updates that will keep you in the know and ahead of the curve.

Are you ready to start reporting MIPS? Open a MIPSPRO account today!

Topics: PRO Tips, MACRA & MIPS, Eligibility