Understanding QPP MIPS Participation

Checking Eligibility for MIPS 2020

To participate in the Quality Payment Program (QPP) MIPS, the first step is to verify your eligibility status. Clinicians can utilize the QPP Lookup Tool to check their eligibility for MIPS 2020. The Centers for Medicare & Medicaid Services (CMS) will subsequently update physicians regarding their eligibility for MIPS data submission.

It is essential to note that reporting requirements evolve each year due to policy changes. Therefore, compliance with these changes is crucial for success in the program.

Reporting Deadline for MIPS 2020

The deadline for submitting MIPS 2020 data is March 31, 2021. As we approach the submission date, clinicians are encouraged to confirm their MIPS eligibility status if they have not done so already. This article will guide you through the complete process to ensure quality reporting.

Participating in MIPS can be complex, and checking eligibility is merely the beginning. Engaging a MIPS Qualified Registry can alleviate administrative burdens, making the process smoother.

MIPS 2020 Eligibility Requirements

Essential Criteria for Participation

According to official guidelines, clinicians interested in MIPS must possess the following:

– A National Provider Identifier (NPI)
– Associated Taxpayer Identification Numbers (TINs)

A TIN is necessary for those who own a practice or work in a medical facility. When physicians reassign their Medicare billing rights to a TIN, their NPI is linked to that TIN, creating a TIN/NPI combination. For instance, if a physician has assigned billing rights to multiple TINs, they will have several TIN/NPI combinations. CMS evaluates these combinations to determine MIPS eligibility and assesses practices based on their TINs.

Eligibility Determination Process

CMS reviews past and current Medicare Part B claims along with data from the Provider Enrollment, Chain, and Ownership System (PECOS) twice a year. The data analysis from the first review is termed preliminary eligibility, while the second review’s data is combined with the first to finalize eligibility determination. To qualify, clinicians must meet the Low-Volume Threshold (LVT) in both reviews.

Defining Low-Volume Threshold (LVT)

The Low-Volume Threshold encompasses three key aspects of professional healthcare services:

– Allowed charges
– Number of services provided
– Number of Medicare patients receiving services

Physicians, aside from exempt cases, must participate in QPP MIPS 2020 if they meet any of the following criteria:

– Bill over $90,000 for Part B covered professional healthcare services
– Serve more than 200 Part B patients
– Offer over 200 covered professional healthcare services to Part B patients

If physicians report Medicare Part B claims under a medical practice’s TIN during the second review, the eligibility status will only reflect data from that review.

Who Can Participate in MIPS 2020?

CMS defines specific clinician types eligible for MIPS participation, which includes:

– Physicians (including MDs, DOs, dentists, podiatrists, and optometrists)
– 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

Participation as Individuals

For individual MIPS participation, physicians must:

– Belong to an eligible clinician type under Medicare Part B claims
– Be enrolled in Medicare prior to the performance year 2020
– Exceed the Low-Volume Threshold requirements
– Not qualify as an Alternative Payment Model Participant

Participation as a Group

If participating as a group, physicians need to:

– Belong to an eligible clinician type under Medicare Part B claims
– Be enrolled in Medicare before the performance year 2020
– Be part of a medical practice that exceeds the Low-Volume Threshold
– Not qualify as an Alternative Payment Model Participant

In this case, the MIPS score and payment adjustment will be allocated as a group.

Participation as a Virtual Group

For virtual group participation, physicians must:

– Belong to an eligible clinician type under Medicare Part B claims
– Be enrolled in Medicare before the performance year 2020
– Not qualify as an Alternative Payment Model Participant
– Be associated with a medical practice that exceeds the Low-Volume Threshold and is part of a virtual practice

These are the prerequisites for MIPS participants to understand before data submission. With the MIPS 2020 timeline progressing, many professionals have already devised and implemented strategies for optimal performance.

How to Report MIPS Data

Physicians face numerous responsibilities, and the added pressure from the pandemic has made MIPS quality reporting more challenging. Eligible MIPS clinicians should focus on achieving quality care outcomes. Engaging a professional MIPS Qualified Registry can help streamline reporting efforts, allowing for a more targeted approach to quality measures.

Best of luck with your MIPS reporting journey.