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) for 2017. To determine your status, enter your national provider identifier (NPI) into the entry field on the tool.

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

After three years of MACRA, the US Secretary of Health and Human Services has the option to expand the definition of a MIPS eligible clinicians to also include:

  • Physical Therapists
  • Occupational Therapists
  • Speech/Language Pathologists
  • Audiologists
  • Nurse Midwives
  • Clinical Social Workers
  • 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 $30K/year OR those who see 100 or fewer Medicare Part B patients per year.
  • Clinicians significantly participating in Advanced APMs

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