• MIPS 2019—Fundamentals: Low-Volume Clinicians Can Opt In to MIPS

    This content was excerpted from EyeNet’s MIPS 2019; also see the Academy’s MIPS hub page


    Some low-volume clinicians will be able to opt in. If you exceed one or two—but not all three—of the low-volume exclusion thresholds, you have a choice of being exempt from MIPS or electing to opt in to the program. (This option isn’t available if you fall below all three thresholds.)

    How do you know if you are eligible for opt-in status? Enter your 10-digit National Provider Identifier (NPI) into the QPP Participation Status lookup tool. This tool will provide information on your status based on the determination period’s first segment (Oct. 1, 2017–Sept. 30, 2018); during the course of this year, that information may be updated based on data from the second segment (Oct. 1, 2018–Sept. 30, 2019).

    How do you opt in to MIPS? CMS has said that clinicians or groups "will be required to complete their opt-in election during the submission period beforer submitting data to CMS." However, at time of press, CMS hadn't finalized the process or deadlines for doing that.

    What are the consequences of opting in? If you opt in for the 2019 performance period, your 2021 payments will be subject to a MIPS payment adjustment based on your 2019 MIPS final score. You also will be eligible to have your data published on Physician Compare, a website that CMS has set up to enable members of the public to see performance data on physicians who participate in Medicare. Once you have elected to opt in to MIPS for 2019, that decision is binding for 2019.

    An alternate option: Voluntary reporting. If you are excluded from MIPS, you can choose to voluntarily report. You will receive feedback reports, but—unlike those who choose to opt in—your 2021 payments won’t be subject to a MIPS payment adjustment, and any quality data that you report won’t be included when CMS calculates measure benchmarks. Note: If you voluntarily report, your performance information may appear on Physician Compare; however, during the 30-day preview period, voluntary reporters can ask that their information not be publicly reported.    

    Previous: Fundamentals: Who Does (and Doesn’t) Take Part in MIPS

    Next: Fundamentals: Use of TINs and NPIs as Identifiers

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