CMS has announced several reasons for providers to be excluded from the upcoming Merit-based Incentive Payment System (MIPS). Again, MIPS is one of the Quality Payment Programs (QPP) under the new regulation called Medicare Access & CHIP Reauthorization Act (MACRA), which replaced the Sustainable Growth Rate (SGR) for physician fee schedule. Under MACRA - CMS is combining the old EHR Incentive Program and Physician Quality Reporting System (PQRS) starting in 2017 and Eligible Professionals will still be required to report your Quality Measures to avoid the 4% penalty in 2019. However, if you meet one of the following, you will be excluded from the penalty and do not have to report. The exclusions are as follows:
1. You are considered a "low-volume" provider if you bill less than $30,000.00 in Medicare allowed charges and/or see fewer than 100 Part B beneficiaries in a given year, you will be automatically excused from MIPS reporting and should receive a notice from Medicare in January of your exclusion status.
2. You're newly Medicare enrolled. Providers who enroll in Medicare during the MIPS reporting period and have never previously billed Medicare are excused from the program until the next reporting period.
3. You qualify for an alternative payment model (APM). If you are a qualified participant and are enrolled in a qualifying APM you are not considered a MIPS-eligible clinician and are excused from MIPS reporting.
CMS will conduct a claims review for all providers to "inform individual MIPS-eligible clinicians and groups of their low-volume status prior to or shortly after the start of the performance period. Please keep in mind if you do not report, you will not be eligible for the MIPS bonus and just because you may qualify to be excluded doesn't mean you cannot report if you wish.
If you wish to find more information about how MEDELECT, Inc. can assist you with MIPS, please do not hesitate to contact us at firstname.lastname@example.org or 877-543-2824.