How CMS Determines MIPS Eligibility?

The QPP MIPS participation starts from knowing the eligibility status. For MIPS 2020, clinicians can check eligibility via QPP Lookup Tool. Later on, CMS updates if physicians are eligible for MIPS data submission or not.

However, the reporting requirements change each year due to changed policies. So, if we want to succeed in this program, we have to comply with the changes.

MIPS 2020 Reporting Deadline is Due March 31, 2021

We have almost 2 months to submit data to CMS. Most of you must have checked their MIPS eligibility status up until now. However, to ensure quality, go through this article to review the complete process.

Also, remember that MIPS participation is not easy, and the eligibility check is just the start. A MIPS Qualified Registry can take care of the administrative load without you being bothered. So, consult them for a seamless process.

 MIPS 2020 Eligibility Check

According to the official website, interested clinicians must have:

• National Provider Identifier (NPI)
• Associated Taxpayer Identification Numbers (TINs)

A TIN is required when you own a practice; belong to a hospital as a medical facility or a medical practice.

In the case of physicians’ reassignment of Medicare Billing Rights to TIN, their NPI gets associated with that TIN, referred to as TIN/NPI combination.

For Instance, if any physician has assigned billing rights to multiple TINs, he/she will have multiple TIN/NPI combinations.

CMS assesses TIN/NPI combination for MIPS eligibility and uses TINs for practices’ eligibility.

Eligibility Determination Period of MIPS

CMS looks into past and current Medicare Part B Claims and Provider Enrollment, Chain, and Ownership System (PECOS) data for clinicians and practices, each year twice.

Data analysis from the first segment is referred to as preliminary eligibility. Data from the second review are then attached to the first segment of data and presented for final eligibility determination. The requirement is to pass the Low-Volume Threshold (LVT) during both reviews.

What is Low-Volume Threshold (LVT)?

LVT includes three aspects of professional healthcare services as follows.

• Allowed charges
• Number of services provided
• Number of Medicare patients who receive services

Other than exempt cases, physicians are required to participate in QPP MIPS 2020, if they:

• Bill above than $90,000 for Part B covered professional healthcare services
• Check more than 200 Part B patients
• Offer above than 200 covered professional healthcare services to Part B patients

It is to consider if physicians report Medicare Part B claims in the second review with a medical practice’s TIN, the eligibility status at that practice will only reflect data from 2nd review.

Who Can Participate in MIPS 2020?

CMS has an eligible clinician type. Clinicians falling into the list and satisfying all the requirements can participate in MIPS.

• Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
• Chiropractors
• Physical therapists
• Occupational therapists
• Clinical psychologists
• Osteopathic practitioners
• Physician assistants
• Nurse practitioners
• Clinical nurse specialists
• Certified registered nurse anesthetists
• Qualified speech-language pathologists
• Qualified audiologists
• Registered dietitians or nutrition professionals

MIPS Data Submission Methods

Eligible physicians can report data to CMS as individuals, a group, or a virtual group.

Eligibility Check for MIPS 2020 Participation as Individuals

For MIPS participation as individuals, physicians must:

• Belong to eligible clinician type on Medicare Part B claims
• Have enrollment in Medicare before the performance year 2020
• Surpass the Low-Volume Threshold requirements
• Not qualify for Alternative Payment Model Participant

Eligibility Check for MIPS 2020 Participation as Group

For MIPS participation as a group, physicians must:

• Belong to eligible clinician type on Medicare Part B claims
• Have enrollment in Medicare before the performance year 2020
• Belong to a medical practice that surpasses the Low-Volume Threshold requirements
• Not qualify for Alternative Payment Model Participant

The MIPS score and payment adjustment will be awarded as a group in this case.

Eligibility Check for MIPS 2020 Participation as Virtual Group

For MIPS participation as a virtual group, physicians must:

• Belong to eligible clinician type on Medicare Part B claims
• Have enrollment in Medicare before the performance year 2020
• Not qualify for Alternative Payment Model Participant
• Be associated with a medical practice that surpasses the Low-Volume Threshold requirements & is part of virtual practice

The above-mentioned are all the requirements that a MIPS participant should know beforehand of the MIPS data submission. We are halfway through QPP MIPS 2020, and many professionals already had planned and implemented a strategy for optimized performance in the end.

How to Report MIPS Data?

Physicians have a lot on their plate already, and the pandemic has increased their burden. In such a situation, MIPS quality reporting seems like a challenging task.

If you’re an eligible MIPS clinician, the best advice to you is to concentrate on quality care outcomes. A professional MIPS Qualified Registry will take your efforts into account, and you can target more measures if you have a proper plan of action on board.

Best of luck.