Check Your Final 2019 MIPS Eligibility Status

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

Your initial 2019 MIPS eligibility status was based on CMS review of Medicare Part B claims and PECOS data from October 1, 2017, to September 30, 2018.

Now, we’ve updated your eligibility status based on our second review of Medicare Part B claims and PECOS data, from October 1, 2018, to September 30, 2019.

Checking Your 2019 Eligibility

Your status may have changed, so we encourage you to use the QPP Participation Status Tool to confirm your final 2019 MIPS eligibility.

If, after the first review earlier this year, you were determined to be:

Eligible for MIPS: Your eligibility status might change, and you may no longer be eligible. You should use the tool to make sure you’re still eligible.
Not eligible for MIPS at a particular practice: Your eligibility status, based on your association with that particular practice, will not change.

Please note, if you joined a new practice (meaning you billed under, or assigned your billing rights to, a new or different TIN) between October 1, 2018, and September 30, 2019, we evaluated your MIPS eligibility based on your association with that new practice (identified by TIN) during this second review.

If you joined a new practice after September 30, 2019, you are not eligible for MIPS as an individual based on your association with that new practice (identified by TIN). However, you may be eligible to receive a MIPS payment adjustment based on your group’s participation, if the new practice you joined chooses to participate in MIPS as a group.

For More Information

Visit the MIPS Participation page on the Quality Payment Program website.
View the 2019 Quality Payment Program Participation Infographic.
Check out the 2019 MIPS Participation and Eligibility Fact Sheet and 2019 MIPS Participation and Eligibility User Guide.

Questions?

Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292 (TTY: 1-877-715-6222). To receive assistance more quickly, consider calling during non-peak hours—before 10 AM and after 2 PM ET.

MIPS Low-Volume Threshold Criteria for 2019 and Participating Through the Opt-In or Voluntary Reporting Options

CMS has added a third low-volume threshold criterion for determining Merit-based Incentive Payment System (MIPS) eligibility for 2019. Clinicians and groups are excluded from MIPS if they:

Billed $90,000 or less in Medicare Part B allowed charges for covered professional services during either of the two determination periods (October 1, 2017 – September 30, 2018 or October 1, 2018 – September 30, 2019); OR
Provided care to 200 or fewer Part B-enrolled patients during either of the two determination periods; OR
New for 2019 – Provided 200 or fewer covered professional services under the Physician Fee Schedule during either of the two determination periods.

In order to be eligible for MIPS, a clinician or group must exceed all three criteria listed above. You can check the Quality Payment Program (QPP) Participation Status Tool to view your final 2019 eligibility status for MIPS.

Participation Options for Clinicians and Groups Not Eligible for MIPS

Clinicians and groups who are not eligible for MIPS can still choose to report data to MIPS:

Make an Election to Opt-in or Voluntarily Report: Clinicians and groups who are identified as “opt-in eligible” on the QPP Participation Status Tool have exceeded one or two of the low-volume threshold criteria, and can make an election to:
- Opt-in to MIPS. You will receive a MIPS payment adjustment (positive, negative or neutral)
- Voluntarily Report. You will not receive a MIPS payment adjustment.
- Note: Once made, your election is binding and irreversible. (No election is required if you don’t want to report data to MIPS.)
Voluntarily Report (no election required): Clinicians and groups who are excluded from MIPS and are not “opt-in eligible” because they fall below all three of the low-volume threshold criteria may choose to voluntarily report data to MIPS and will not receive a MIPS payment adjustment.

Next Steps

To review your eligibility status, enter your National Provider Identifier (NPI) on the QPP Participation Status Tool or sign in to qpp.cms.gov to review your eligibility as a group and individually for all the clinicians associated with your practice.

Before reporting data, opt-in eligible clinicians and groups will need to complete an election to opt-in or voluntarily report in MIPS by signing in to qpp.cms.gov. Qualified Registries and Qualified Clinician Data Registries (QCDRs) can also submit elections on behalf of clinicians and groups. Elections can be made once the 2019 MIPS submission period opens on January 2, 2020.

For More Information