Excerpted from “MIPS—What’s New for 2019”, a two-part EyeNet series (January and February, 2019) published online ahead of print. You also should bookmark EyeNet's MIPS 2019 (also published online ahead of print) and the Academy's MIPS hub page.
Several determination periods are consolidated into one. Each year, CMS uses Medicare data to make several determinations about your MIPS eligibility and status. Two examples: Do you qualify for a low-volume exclusion? Is your practice considered small or large? For 2019, CMS will make most of these decisions based on data from a two-segment determination period that is aligned with the government’s fiscal year:
- Oct. 1, 2017–Sept. 30, 2018 (plus a 30-day claims run out)
- Oct. 1, 2018–Sept. 30, 2019 (no claims run out)
If, for example, you fall below a low-volume threshold in the first time segment, you would qualify for the low-volume exclusion even if you exceed the same threshold in the second time segment.
What has changed? Previously, some of these decisions were based on a Sept. 1–Aug. 31 timeline; they had differences in their claims run-out policies; and the practice-size determination was based solely on historic data.
Check your quarterly snapshots. During the determination period’s second time segment (Oct. 1, 2018 –Sept. 30, 2019), CMS hopes to provide you with quarterly snapshots that would show—based on the data available at that point in time—what the agency’s provisional status and eligibility determinations would be for you. Although the final determinations won’t be made until after Sept. 30, 2019, these snapshots will give you a sense of what those final decisions are likely to be.
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