Physicians can now check the Quality Payment Program (QPP) Participation Status Tool to view their 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 2019 MIPS eligibility status

CMS reviews both PECOS data and Medicare Part B claims for services provided during two 12-month segments, called the MIPS determination period.

• First segment: Oct. 1, 2017, through Sept. 30, 2018. 
  o Includes a 30-day claims run-out period.
• Second segment: Oct. 1, 2018, through Sept. 30, 2019. 
  o Does not include a claims run-out period.

The most recent QPP Participation Status Tool update shows physicians’ preliminary 2019 eligibility status based on data from Oct. 1, 2017, to Sept. 30, 2018.  

Later this year, CMS will review PECOS and Medicare Part B claims data from Oct. 1, 2018. to Sept. 30, 2019, and update the Status Tool to reflect physicians’ final 2019 MIPS eligibility status.

Note: If a physician joined a new practice and started billing to a new or different tax-identification number (TIN) after Sept. 30, 2018, CMS will evaluate eligibility under that practice during the second segment of the MIPS determination period.

Changes to the Low-Volume Threshold for exclusion from MIPS

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.

For More Information

• Visit the About MIPS Participation page on the Quality Payment Program website
• View the 2019 MIPS Quick Start Guide (PDF) and the QPP Year 3 Final Rule Overview Fact Sheet (PDF)
• View the 2019 MIPS Eligibility and Participation Fact Sheet (PDF)

Questions? Contact the Quality Payment Program at (866) 288-8292 (TTY: (877) 715-6222).