Payment & Delivery Models

Need to know your MIPS participation status? Find out online

Tanya Albert Henry , Contributing News Writer

A new online tool lets physicians enter their National Provider Identifier (NPI) to find out their participation status in the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) this year.

Physicians who bill Medicare Part B more than $30,000 in allowed charges and see more than 100 unique Medicare patients annually will participate in MIPS, a modified fee-for-service program created when the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the sustainable growth rate (SGR). MIPS is one of two payment tracks created under MACRA; some physicians will participate in Advanced Alternative Payment Models (AAPMs).

While the new online tool is a good way for physicians to check whether their individual status meets the MIPS participation threshold, it is also important for physicians who are part of group practices to check their status with the new tool. Some physicians are exempt individually, but may be included in MIPS if their tax identification number (TIN) chooses to report as a group. By entering their NPI, physicians can find out whether they are included in MIPS in the event that their TIN decides to participate as a group. The website gives physicians their status for each TIN in which they practice.

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Physicians should have recently received a letter in the mail notifying them of their MIPS participation status, according to the Centers for Medicare & Medicaid Services (CMS). Some physicians, however, may be unaware of their participation status because CMS sent the notification letters to addresses linked to TINs, but not those affiliated with individual NPIs. If an individual physician is below the low-volume threshold, but the TIN decides to report as a group, the physician’s performance will influence the group’s performance score.

Under MIPS, physicians will attest to self-reported measures that are focused on clinical quality, technology and new approaches to care. Physicians can pick their pace of participation in MIPS this year. Doctors are required to report just one quality measure, one improvement activity, or the base Advancing Care Information measures this year to avoid a pay cut in 2019. Physicians who report nothing face a 4 percent pay cut in 2019. Doctors who do more than the minimum will have a chance to see an increase in pay in 2019.

Physicians who are not in the MIPS program in 2017 can participate voluntarily and not be subject to payment adjustments.

The CMS QPP website contains more information and resources for doctors. The AMA also has a Payment Model Evaluator to help physicians decide whether they should participate in the MIPS or Advanced APM track. In addition, the AMA offers resources to help physicians navigate MIPS, guidance to help physicians better understand what is required under MACRA and information to help doctors understand and participate in the Advanced APM track.

AMA Washington Counsel Ashley McGlone and Laura Hoffman, AMA assistant director of federal affairs, answered the top questions physicians have about MACRA during a recent ReachMD podcast. It is part of a podcast series, “Inside Medicare’s New Payment System.”