How is MIPS Eligibility Determined? 

MIPS, (or Merit Based Incentive Payment System) eligibility is mandatory for many clinicians that meet three low-volume thresholds. These minimums are (1) having more than 200 Medicare Part B patients, (2) having more than $90,000 in associated medical billing per year, and (3) covering more than 200 professional services during the performance period. 

Participants also need to be one of the following types of clinicians: 

  • 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 

For the 2022 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 

2022 MIPS Eligibility  

If a clinician does not exceed all three of the low-volume threshold criteria, they may still choose to voluntarily participate in MIPS in order to receive feedback on their performance and qualify for payments. Additionally, if a clinician exceeds at least one of the three criteria they may elect to opt-in and be eligible for a positive adjustment. 

For more information on MIPS eligibility criteria, contact our team today or download our MIPS 2022 Guidebook here