Who’s in, who’s out when it comes to MACRA participation

CMS will exempt more than 800,000 physicians from participation in MIPS this year.

The Centers for Medicare & Medicaid Services had good news for more than 800,000 physicians who received notification this month that they do not need to participate in MACRA’s MIPS program this year.

The agency mailed out letters to medical practices providing clinicians with their participation status in the Merit-based Incentive Payment System (MIPS), one of two payment tracks implemented as part of the Medicare Access and CHIP Reauthorization Act (MACRA). Some 418,849 clinicians were notified that they are participating in MIPS and must meet reporting requirements for 2017, a CMS spokesman told FierceHealthcare in an email. 

And 806,879 clinicians got a reprieve with news that they are not currently required to participate in MIPS, the spokesman said. Physicians are exempt from MIPS participation if they have less than $30,000 in Medicare charges and fewer than 100 Medicare patients per year. Clinicians new to Medicare this year are also exempt.

Doctors have been waiting to find out if they must report quality measures under MIPS after CMS missed a December notification deadline. Letters were finally mailed this month.

The actual number of clinicians participating in MACRA will be higher than the 418,849 figure. Other clinicians will also participate in MACRA this year through alternative payment models (APMs). CMS expected the majority of physician practices would initially participate under MIPS as opposed to APMs, a pathway that offers doctors the greatest financial reward but also requires them to take on more risk.

The numbers of MIPS participants differed from estimates in the MACRA final rule released last fall, based on an updated formula for determining eligibility. Under MIPS, physicians will receive Medicare payments based on quality measures and their use of electronic health records.

MACRA's impact on small and rural physician practices has been a major concern, because they do not have the administrative resources to take on the data gathering and reporting required by MIPS. Many doctors are hoping new Health and Human Services Secretary Tom Price will make the Medicare payment system easier for them by reducing the reporting burden.

Price, an orthopedic surgeon who has voiced those same worries, will get his first chance to make a mark on MACRA with the release of a proposed Medicare rule, which is expected in the coming weeks.

RELATED: Doctors look to HHS Secretary Tom Price to provide MACRA relief; proposed Medicare rule in the works

Physicians still unsure if they must participate in MIPS can visit qpp.cms.gov, click on the MIPS Participation Look-up Tool and use their National Provider Identifier (NPI) to check their status.