The Merit-Based Incentive Payment System (MIPS) is a performance-based program that impacts Medicare payments for eligible clinicians. To determine if you need to participate in MIPS 2024 performance year, you must meet certain eligibility requirements. Are you eligible for MIPS? Check your status here.
Let’s break it down.
MIPS Eligibility Criteria
To be required to participate in MIPS, clinicians must meet all three of the following low-volume threshold criteria during the performance period:
1) see more than 200 Medicare Part B patients
2) bill more than $90,000 in Medicare Part B covered professional services associated medical billing
3) provide more than 200 professional services to Medicare Part B patients during the performance period.
Additionally, clinicians must fall into one of the following categories:
- Physicians
- Osteopathic Practitioners
- Chiropractors
- Physician Assistants
- Nurse Practitioners
- Clinical Nurse Specialists
- Certified Registered Nurse Anesthetists
- Physical Therapists
- Occupational Therapists
- Clinical Psychologists
- Qualified Speech-Language Pathologists
- Qualified Audiologists
- Registered Dietitians or Nutrition Professionals
- Clinical Social Workers
- Certified Nurse-Midwives
Exceptions to MIPS Eligibility
For the 2024 performance year, CMS grants three exceptions from MIPS for clinicians who otherwise meet the eligibility requirements above. These are:
- Clinicians in their first year of Medicare Part B participation
- Clinicians billing Medicare Part B up to $90,000 in allowable charges or providing care for up to 200 Part B patients and covering up to 200 professional services in one year
- Clinicians in entities sufficiently participating in an Advanced APM which either:
Receives 50% of Medicare Part B payments through an Advanced APM or sees 35% of Medicare patients through an Advanced APM
Voluntary and Opt-In Participation
Clinicians who do not meet all three low-volume threshold criteria can still voluntarily participate in MIPS. This allows them to receive performance feedback without being subject to payment adjustments. Additionally, clinicians who meet at least one of the three criteria may choose to opt-in to MIPS and become eligible for a potential positive payment adjustment
If you have further questions or need assistance, our team is here to help. Contact us today or fill out the request below for our comprehensive MIPS 2024 Guidebook to ensure you’re on the right track!