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 they bill more than $30,000 in allowed Medicare charges or provide care to 100 or more Medicare patients per year, and are a:

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

For 2018 the threshold raises to more than $90,000 in allowed Medicare charges or provide care to 200 or more  Medicare patients per year. 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

There are three exemptions from MIPS for clinicians who otherwise meet the eligibility requirements:

  • First year Medicare Part B participants
  • Low volume
    • 2017: Clinicians billing $30,000 or less in allowed Medicare Part B charges or providing care for fewer than 100 Part B patients in one year
    • 2018: Clinicians billing $90,000 or less in allowed Medicare Part B charges or providing care for fewer than 200 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.

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