Healthmonix Advisor

To Do: Check Your MIPS Eligibility Status, Preview Your QPP Data.

Posted by Christina Zink on December 14, 2018
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Have you checked your 2018 MIPS eligibility status? Since September?

CMS emailed physicians to let them know that their MIPS status for this year may have changed that recently--and some physicians may find that they are no longer eligible to participate. Although CMS conducted an initial review of Medicare Part B claims and Provider Enrollment, Chain, and Ownership System (PECOS) data between September 2016 and August 2017, further updates were made after a second review that took place between September 2017 and August 2018. If you are eligible, your 2018 performance will affect your 2020 Medicare payment adjustment.

How can you tell if you're still eligible?

The surest way is to check the Quality Payment Program (QPP) Participation Status Tool to review your eligibility for 2018 MIPS. CMS did outline several factors that may influence your status:

1. If you joined a new practice after August 31 2018, you are not eligible as an individual, but you could receive a payment adjustment based on your practice group’s MIPS participation.

2. If you: a. billed < $90,000 in Medicare Part B allowed charges during either of two determination periods (September 1, 2016, to August 31, 2017, or September 1, 2017, to August 31, 2018) or, b. provided covered professional services to < 200 Medicare Part B-enrolled patients during either of those periods.

You or your group must exceed both of these criteria to achieve MIPS eligibility.

If you know you were considered exempt from MIPS after the initial data review, you will remain exempt, even if the second review found that you exceeded the threshold.


Preview your QPP data before December 31.

Another item on the to-do list: check your QPP performance information. CMS is giving physicians the opportunity to preview their information before it shows up on Physician Compare. The official 30-day preview period for 2017 data ends December 31, at 8PM ET.

Visit for more information about the Quality Payment Program. Or if you want more information about MIPS, check out our MIPS Learning Center and Resource Library.


Topics: PRO Tips, MACRA & MIPS, Eligibility