The Quality Payment Program was created under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and began on January 1, 2017. The Quality Payment Program has two paths for participation:
Under these program regulations, CMS replaced the term eligible professional, or EP, with eligible clinician, or EC. Find out if you’re an eligible clinician under the Quality Payment Program by reviewing CMS’ MIPS eligibility criteria below.
Who are the MIPS eligible clinicians?
A MIPS eligible clinician is defined as the following licensed providers and any group that includes such professionals:
- Physicians including:
- Doctors of medicine
- Doctors of osteopathy
- Osteopathic practitioners
- Doctors of dental surgery
- Doctors of dental medicine
- Doctors of podiatric medicine
- Doctors of optometry
- Physician assistants
- Nurse practitioners
- Clinical nurse specialists
- Certified registered nurse anesthetists
- Clinicians who have billed more than $90,000 in Medicare Part B allowable charges and have more than 200 Part B-enrolled Medicare beneficiaries
Who is exempt for MIPS in 2018?
- Clinicians who are not one of the clinician types above
- Clinicians who enroll in Medicare for the first time in 2018
- Clinicians who participate in an Advanced APM and are either a Qualifying APM Participant (QP) or Partial QP
- Clinicians who are not in a MIPS eligible specialty
- Clinicians or groups that have billed $90,000 or less in Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare secondary Payer)
- Clinicians or groups that have 200 or fewer Medicare Part B FFS beneficiaries
If you're exempt from MIPS for Performance Year 2018, you are not required to participate. However, you are encouraged to check your participation status again if you've made any changes that may change your eligibility status. You can check your eligibility status on the CMS Quality Payment Program website by entering your NPI into the QPP Participation Status Look-Up tool.