Compared to the current CMS quality initiatives, the pool of eligible clinicians (formerly called eligible providers) will be shrinking significantly for the 2019 performance year. Considering that by 2019, when the pool of eligible clinicians will expand, the MIPS payment adjustment will be up to 7%.
Please note that CMS defines a physician as "a doctor of medicine, doctor of osteopathy (including osteopathic practitioner), doctor of dental surgery, doctor of dental medicine, doctor of pediatric medicine, or doctor of optometry, and, with respect to certain specified treatment, a doctor of chiropractic legally authorized to practice by a state in which he/she performs this function."
If an eligible clinician is a part of an Advanced APM, they are exempt from MIPS reporting. Current examples of APMs are Accountable Care Organizations (ACO), Patient Centered Medical Homes, and bundled payment models.
Have ≤ $90K in Part B allowed charges for covered professional services.
Provide care to ≤ 200 Part B enrolled beneficiaries.
Provide ≤ 200 covered professional services under the Physician Fee Schedule (PFS).
If a clinician enrolls in Medicare in the middle of a performance year, they do not have to participate in MIPS reporting that year. For example, if a clinician was to enroll in Medicare on February 6, 2019, they will be exempt for the 2019 performance year (January 1, 2019- December 31, 2019).
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