• MIPS 2019—Fundamentals: Small or Large Practice?

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


    The impact of some MIPS regulations depends on the size of your practice.

    How CMS determines practice size. CMS determines how many eligible clinicians are in a practice by reviewing claims data and looking at the number of National Provider Identifiers (NPIs) associated with the practice’s Tax Identifier Number (TIN). This would include NPIs of eligible clinicians who are not MIPS eligible clinicians—see Who Does (and Doesn’t) Take Part in MIPS.

    Next, it designates practice size as follows:

    • Small practices have 15 or fewer eligible clinicians.
    • Large practices have 16 or more eligible clinicians.

    What claims data does CMS look at? In determining practice size for the 2019 performance year, CMS looks at claims data from the MIPS determination period, which consists of two time segments:

    • 1, 2017–Sept. 30, 2018 (with a 30-day claims run out)
    • 1, 2018–Sept. 30, 2019 (no claims run out)

    Has CMS designated your practice as small or large? Check online by using the QPP Participation Status lookup tool.

    Previous: Fundamentals: Report as an Individual or as Part of a Group?

    Next: Fundamentals: Quakes, Fires, and Other Disasters!

    DISCLAIMER AND LIMITATION OF LIABILITY: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.

    COPYRIGHT© 2019, American Academy of Ophthalmology, Inc.® All rights reserved. No part of this publication may be reproduced without written permission from the publisher. American Academy of Ophthalmic Executives® and IRIS® Registry, among other marks, are trademarks of the American Academy of Ophthalmology®.

    All of the American Academy of Ophthalmology (AAO)–developed quality measures are copyrighted by the AAO’s H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care (see terms of use).