MIPS Participation Notification Letters

MIPS Participation Notification Letters

Originally slated to be sent in December 2016, Medicare Administrative Contractor are currently sending MIPS (Merit Based Incentive Payment System) participation letters throughout April and May. These Quality Payment Program participation levels are being sent to clinicians enrolled in Medicare Part B.

The letters’ main purpose is to let clinicians know if they are required to participate in the Merit-based Incentive Payment System or if they will be exempt due to falling below the low-volume provider threshold set in place by the current guidelines.

Those who bill a total of less than $30,000 in Medicare Part B charges or who deliver medical care to fewer than 100 Medicare Part B enrollees during either of the two years preceding 2017 will be exempt from MIPS. This threshold remains the same whether a provider reports as a group or reports individually.

MIPS is designed to provide payment adjustments based on quality measures and other criteria by a medical professional when accepting Medicare Part B from their patients. It could provide increased payments or trigger penalties and fees depending upon how well the provider compares to peers in respect to submitting quality measures, meeting quality improvement goals and the cost to Medicare of their patients.

Under the rules regarding the transition years, those clinicians who are eligible will be able to choose from several different participation tracks within the MIPS umbrella. These types of participation range from partial participation to full participation, and those who participate at practically any level will find that they are able to avoid negative adjustments on payments in 2019. Those payment adjustments for 2019 will be based on the data that is reported during the 2017 calendar year – whether they are positive or negative. Only the medical professionals who report no data to CMS will end up receiving the maximum negative payment adjustment of four percent.

Those providers who don’t want to wait for their MIPS participation letter to arrive can use the internet to inquire as to their status. CMS has set up a web page that allows clinicians to visit and determine whether they are required to submit their data to MIPS. Upon visiting the website, you need only enter your 10 digit NPI.

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