MIPS: Find out if you are in or out for 2018

Finally. The Centers for Medicare & Medicaid Services (CMS) has released an online tool that enables clinicians to determine whether they must participate in the Merit-Based Incentive Payment Program (MIPS) this year.

CMS on Friday put out a notice that it has released an updated MIPS Participation Lookup Tool on its web site that will allow clinicians to check on their 2018 eligibility status.

Clinicians can enter their National Provider Identifier to find out whether they need to participate in the Medicare physician payment system during the 2018 performance year.

Both the American Medical Association and the Medical Group Management Association had appealed to CMS back in January to release the critical information for physicians. The second year of MIPS and its quality reporting requirements started Jan. 1, yet physicians were not sure if they were in or out of the program.

In fact, given new threshold requirements for the MIPS program in 2018, CMS estimates more than 500,000 clinicians will be excluded from MIPS this year.

In its notice about the 2018 MIPS eligibility tool, CMS makes note of the changes to its low-volume threshold requirements. To reduce the burden on small practices, CMS changed the threshold to exclude clinicians and groups if they:

  • Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule


  • Furnished covered professional services to 200 or fewer Medicare Part B-enrolled beneficiaries

In other words, to be included in MIPS in 2018, clinicians or groups need to have billed more than $90,000 in Medicare Part B allowed charged AND furnished services to more than 200 beneficiaries.

(The threshold exempts even more physicians, since in 2017, clinicians had to participate in MIPS if they billed Medicare Part B more than $30,000 a year and saw more than 100 Medicare patients a year.)

CMS noted that the participation lookup tool for Alternative Payment Models (APMs) will be updated at a later time.

In 2017, CMS didn’t release eligibility information until April. But this year, MIPS quality reporting has increased from 90 to 365 days and mandates a full-year of quality reporting starting Jan. 1.

Eligible clinicians—including physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse practitioners—can plug their national provider identifiers into the tool to ascertain their MIPS eligibility.

In its email update Friday, CMS also announced an upcoming webinar to help clinicians participating in MIPS APMs to transition to advanced APMs, the other payment model implemented under the Medicare Access and CHIP Reauthorization Act. The webinar, held jointly between CMS and America’s Physician Groups, will be held April 30. Those who want to participate can sign up online.

Groups like the Medicare Payment Advisory Commission (MedPAC) have had harsh criticism for MIPS, but a number of challenges stand in the way of moving forward with an alternative. MedPAC is recommending Congress replace MIPS because the Medicare payment system for physicians is flawed.