MIPS-Eligible Clinicians

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
  • Chiropractors
  • Physician Assistants (PA)
  • Nurse Practitioners (NP)
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists
  • Physical Therapists
  • Occupational Therapists
  • Speech/Language Pathologists
  • Audiologists
  • 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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