MIPS Eligibility, Exclusions, and Exemptions

Find out what it takes to be a MIPS clinician

MIPS is a multi-year program that will expand both eligibility and risk over the first several years.

Eligible Providers

For 2017, clinicians are eligible to participate in MIPS if you bill more than $30,000 to Medicare or provide care to more than 100 Medicare patients per year, and are a:

  • Physician
  • Physician Assistant
  • Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registered Nurse Anesthetist

Starting in 2019, eligibility is expanded to physical and occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians/nutritional professionals.

Excluded from MIPS Payment Adjustments

Excluded from MIPS payment adjustments are payments from Medicare Part A, Medicare Advantage Part C, Medicare Part D, FQHC, or Rural Health Clinic facility payments billed under all-inclusive payment methodologies, and CAH Method I facility payments.

Exemptions from MIPS

In 2017, there are three exemptions from MIPS for clinicians who otherwise meet the eligibility requirements:

  • First year Medicare Part B participants
  • Clinicians billing Medicare Part B less than $30,000 in allowed charges or providing care for fewer than 100 Part B patients in one year
  • Providers sufficiently participating in an Advanced APM

CMS continues to refine program requirements, including eligibility for future years/programs, so it is critical to keep up with the latest regulatory changes.

Confused? Concerned?

SA Ignite is ready to help you maximize your participation in MIPS or an APM in order to receive the highest possible rewards. See how we can streamline the process.

Request a Demo