CMS Quality Payment Program: Clinicians Should Expect MIPS Participation Status Letter This Month

Thursday, May 4th, 2017
This post was written by Melanie Matthews

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CMS has specified two key criteria for MIPS participation.

The Center for Medicare and Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS), according to information on MLNConnects, the CMS Medical Learning Network.

MIPS is an important part of the new Quality Payment Program (QPP). In late April through May, clinicians will get a letter from their Medicare administrative contractor that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with their Taxpayer Identification Number (TIN).

Clinicians should participate in MIPS in the 2017 transition year if they meet the following conditions:

  • Bill more than $30,000 in Medicare Part B allowed charges a year; and
  • Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year.

The QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate (SGR) formula and streamlines the “Legacy Programs:” Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program.

During this first year of the QPP program, CMS said it is committed to working with clinicians to streamline the process as much as possible. The federal payor stated that its goal is to further reduce burdensome requirements so that providers can deliver the best possible care to patients.

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