Check Your Preliminary 2019 MIPS Eligibility on the QPP Website

You can now check the Quality Payment Program (QPP) Participation Status Tool to view your eligibility status for the 2019 performance period under the Merit-based Incentive Payment System (MIPS).

Enter your National Provider Identifier (NPI), to find out if you need to participate in MIPS during the 2019 performance year.

How CMS Determines Your 2019 MIPS Eligibility Status

We review both PECOS data and Medicare Part B claims for services provided during two 12-month segments called the MIPS determination period.

First segment: October 1, 2017 through September 30, 2018.
- Includes a 30-day claims run out period.
Second segment: October 1, 2018 through September 30, 2019.
- Does not include a claims run out period.

Today’ QPP Participation Status Tool update shows your preliminary 2019 eligibility status based on data from October 1, 2017 to September 30, 2018.

Later this year, we will review PECOS and Medicare Part B claims data from October 1, 2018 to September 30, 2019, and update the QPP Participation Status Tool to reflect your final 2019 MIPS eligibility status.

Note: If you joined a new practice and started billing to a new or different TIN after September 30, 2018, we will evaluate your eligibility under that practice during the second segment of the MIPS determination period.

Changes to the Low-Volume Threshold

We’ve updated the low-volume threshold criteria for the 2019 performance year. Clinicians and groups are excluded from MIPS in 2019 if, during either segment of the MIPS determination period, they:

Bill $90,000 or less in Medicare Part B allowed charges for covered professional services payable under the Physician Fee Schedule (PFS), OR
Furnish covered professional services to 200 or fewer Medicare Part B-enrolled beneficiaries, OR
Provide 200 or fewer covered professional services to Medicare Part B-enrolled beneficiaries.

Clinicians and groups who are currently identified as eligible (exceeding all three elements of the low-volume threshold) must exceed all three elements of the low-volume threshold in the second segment to remain eligible, unless they opt into MIPS participation as discussed below.

Opting In to MIPS Participation

Clinicians and groups can elect to “opt-in” to MIPS if they meet or exceed one or two, but not all, of the low-volume threshold criteria. Clinicians and groups who do not exceed any of the low-volume threshold criteria (in one or both segments of the MIPS determination period) may voluntarily report, but are not able to opt-in.

Clinicians and groups that opt-in will receive a MIPS payment adjustment in 2021.
Clinicians and groups that voluntarily report will receive a MIPS final score, but no payment adjustment will be applied.

For More Information

Visit the About MIPS Participation page on the Quality Payment Program website
View the 2019 MIPS Quick Start Guide and the QPP Year 3 Final Rule Overview Fact Sheet
View the 2019 MIPS Eligibility and Participation Fact Sheet

Questions?

Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292 (TTY: 1-877-715-6222).

Register for February 27 Webinar: Eligible Clinician eCQMs with Substantive Changes for the 2019 Performance Year

Webinar Details

Title: Eligible Clinician eCQMs with Substantive Changes for the 2019 Performance Year

Date: Wednesday, February 27, 2019

Time: 1:00 p.m. to 2:00 p.m. EST

Registration Link: https://event.on24.com/wcc/r/1894265/5BD0F208DD1DEB33D1A4775AE47FBE69

This one-hour session will provide an in-depth review of the following electronic clinical quality measures (eCQMs) with substantive changes for the 2019 performance year: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan (CMS69), Depression Remission at Twelve Months (CMS159), and Depression Utilization of the PHQ-9 Tool (CMS160). CMS has transitioned the logic used in eCQMs from the previous quality data model (QDM) logic expression language to Clinical Quality Language (CQL) for the 2019 performance year. This session will provide an introduction to the eCQMs with substantive changes for the 2019 performance year and address terminology and value set changes for 2019 Merit-based Incentive Payment System (MIPS) Quality performance year. As a result of the feedback received from stakeholders interviewed through the CMS eCQM Strategy Project to reduce implementation and reporting burdens, this session is intended to prepare eligible clinicians, vendors, quality, and health information technology staff for eCQM reporting, and is the fourth in a series of five educational sessions to provide relevant information to support successful understanding, interpretation, and implementation of eCQMs.

At the end of this eCQMs with substantive changes session, participants will be able to:

Understand the new CQL expression language for eCQMs with substantive changes for the 2019 performance year
Address the most frequently asked questions and answers for each eCQM and how to follow ongoing information about each measure
Learn about changes to these eCQMs for 2019 MIPS reporting

Space is limited for this webinar. Registration will close when we have reached maximum capacity. This webinar will be recorded. If you are unable to participate, a replay of the webinar with presentation slides will be available on the eCQI Resource Center website within 2 weeks following the program.