Who are the MIPS-eligible clinicians?
Clinicians can now use an interactive tool to determine if they should participate in the Merit-based Incentive Payment System (MIPS). To determine your status, enter your national provider identifier (NPI) into the entry field on the tool.
Clinicians who will participate in MIPS:
CMS has proposed that a MIPS-eligible clinician be defined as the following licensed providers and any group that includes such professionals:
- Doctors of Medicine (MD)
- Doctors of Osteopathy (DO)
- Doctors of Dental Surgery/Dental Medicine (DMD/DDS)
- Doctors of Podiatry
- Doctors of Optometry
- Physician Assistants (PA)
- Nurse Practitioners (NP)
- Clinical Nurse Specialists
- Certified Registered Nurse Anesthetists
- Physical Therapists
- Occupational Therapists
- Speech/Language Pathologists
- Clinical Psychologists
- Dietitians & Nutritional Professionals
Clinicians who will not participate in MIPS:
- Clinicians newly enrolled in Medicare
- Clinicians below the low-volume threshold: Medicare Part B-allowed charges less than or equal to $90K/year, those who provide less than or equal to 200 covered professional serviced under the Physician Fee Schedule (PFS), OR those who see 200 or fewer Medicare Part B patients per year.
- Clinicians significantly participating in Advanced APMs
However, beginning in 2019, providers who do not meet at least 1 of the low-volume criteria may choose to opt-in to the MIPS program, submit data, and receive payment adjustments two (2) years after the reporting year.
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