CMS: Expect MIPS eligibility notices in next month

Clinicians should soon be receiving notices on whether they’ll be required to participate in the new Merit-based Incentive Payment System (MIPS), CMS said in a notice issued on April 25.

MIPS is one of the two new payment tracks established by the Medicare Access and CHIP Reauthorization Act (MACRA). After concerns about rushing the transition to a new payment system, CMS allowed “pick your pace” options for MIPS reporting in 2017.

With nearly of a third of the year having passed, however, providers haven’t received notices on whether they’re qualified for MIPS. The Medical Group Management Association wrote to CMS in March asking for a quick release on the overdue eligibility information, including “low volume threshold exemptions, status as hospital-based or non-patient-facing, as well as approved lists of registry vendors.”

It appears CMS is now addressing those concerns, with MIPS eligibility letters being sent out over the next month.

“In late April through May, practices will get a letter from the Medicare Administrative Contractor that processes Medicare Part B claims. This letter will tell the participation status of each MIPS clinician associated with the Taxpayer Identification Number or TIN in a practice,” the CMS notice read.

Clinicians will be told they should participate in MIPS for the 2017 transition year if they bill more than $30,000 in Medicare Part B allowed charges annually and provide care for more than 100 Part B-enrolled Medicare beneficiaries per year.

As discussed at the American College of Healthcare Executives (ACHE) Congress in Chicago, this low-volume threshold may affect healthcare leaders’ decisions to have clinicians report individually or as a group in MIPS. The exemption is judged at reporting entity level, and clinicians can’t pick and choose which MIPS measures they report as a group.

“You get to four-person group, you almost automatically go over the threshold,” said Martie Ross, principal at consultant company Pershing Yoakley and Associates (PYA). “This is happening for rural health clinics. None of those individual physicians are going to have very many Part B charges, but when they aggregate everything ... all of a sudden you’re way above $30,000 for that group.”