Check Your Preliminary 2019 MIPS Eligibility

Members & Publications

February 13, 2019

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

The Centers for Medicare and Medicaid Services (CMS) 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’s 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, CMS 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

CMS has 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.

Meet Your MIPS Requirements

If you are MIPS-eligible, check out AAPM&R's Registry, the MIPS reporting tool for physiatry. 

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.