What is a MIPS eligible clinician in 2018?

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
  • Chiropractors
  • 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.

More information:

Quality Payment Program

  1. 2018 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  2. What is the MIPS Dashboard watch list and how do I use it?
  3. How does the MIPS Dashboard work?
  4. What is the Promoting Interoperability (formerly Advancing Care Information) performance category in MIPS?
  5. 2018 What is the Quality performance category in MIPS?
  6. 2018 What are Improvement Activities in MIPS?
  7. Which Improvement Activities qualify for the Promoting Interoperability performance category bonus in 2018?
  8. What is the Cost performance category of MIPS and how is it scored in 2018?
  9. How is the MIPS Final Score Calculated in 2018?
  10. What is a MIPS eligible clinician in 2018?
  11. MIPS for Small, Rural and Underserved Practices
  12. 2018 PI Transition Measure: Medication Reconciliation
  13. 2018 PI Transition Measure: Electronic Prescribing (eRx)
  14. 2018 PI Transition Measure: Secure Messaging
  15. 2018 PI Transition Measure: Security Risk Analysis
  16. 2018 PI Transition Measure: Health Information Exchange
  17. 2018 PI Transition Measure: Immunization Registry Reporting
  18. 2018 PI Transition Measure: Specialized Registry Reporting
  19. 2018 PI Transition Measure: Syndromic Surveillance Reporting
  20. 2018 PI Transitional Measure: View, Download, or Transmit (VDT)
  21. 2018 PI Transition Measure: Provide Patient Access
  22. 2018 PI Transition Measure: Patient-Specific Education
  23. What is the Practice Fusion QCDR?
  24. 2017 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  25. How do I report my 2017 MIPS data to CMS using the Practice Fusion QCDR?
  26. What is the Advancing Care Information (ACI) Performance Category for MIPS and how is it scored?
  27. 2017 ACI Transition Measure: Security Risk Analysis
  28. 2017 ACI Transition Measure: Electronic Prescribing (eRx)
  29. 2017 ACI Transition Measure: Provide Patient Access
  30. 2017 ACI Transition Measure: Health Information Exchange
  31. 2017 ACI Transition Measure: View, Download, or Transmit (VDT)
  32. 2017 ACI Transition Measure: Patient-Specific Education
  33. 2017 ACI Transition Measure: Secure Messaging
  34. 2017 ACI Transition Measure: Medication Reconciliation
  35. 2017 ACI Transition Measure: Immunization Registry Reporting
  36. 2017 ACI Bonus Measure: Syndromic Surveillance Reporting
  37. 2017 ACI Bonus Measure: Specialized Registry Reporting
  38. What is the Improvement Activities Performance Category for MIPS?
  39. What are the Quality performance category reporting requirements for MIPS?
  40. What is the difference between the two Advancing Care Information measure sets available in 2017?
  41. What are Alternative Payment Models (APMs) and Advanced APMs?
  42. What is Comprehensive Primary Care Plus (CPC+)?
  43. Which Improvement Activities Qualify for the Advancing Care Information (ACI) Bonus Score in 2017?
  44. How do I contact CMS about the Quality Payment Program?
  45. How do I indicate interest in the Practice Fusion QCDR and get my MIPS estimated scores?
  46. Chronic Care Management FAQs
  47. How do I export a JSON file for 2017 MIPS reporting?
  48. How is the MIPS Final Score Calculated in 2017?

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