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Healthcare is always changing. Doctors need to stay updated on MIPS eligibility and options for programs like MIPS (Merit-based Incentive Payment System).
MIPS plays a significant role in determining payment adjustments based on performance in various categories. To ensure they remain eligible and make the most of available opportunities, clinicians must keep up to date with the criteria for participation, performance measures, and how changes each year might affect their practice.
In this guide, we will give you a clear overview of the important details about MIPS eligibility and participation for 2023 and 2024.
Let’s get started!
Status Update on MIPS Eligibility 2023
Clinicians can check their final MIPS eligibility for 2023 using the Quality Payment Program (QPP) Participation Status Tool. This status is determined by reviewing Medicare Part B claims and data from the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) between October 1, 2022, and September 30, 2023.
The eligibility status is final unless a clinician is part of an Advanced Alternative Payment Model (APM). In that case, changes to their status as Qualifying APM Participants (QP) will be based on a snapshot taken during the 2023 performance year.
Clinicians should use the QPP Participation Status Tool to confirm their eligibility for 2023 especially if there have been changes in their practice or billing during the eligibility period.
2023 MIPS Low-Volume Threshold Criteria
For the 2023 performance year, clinicians and groups may be excluded from MIPS if they meet certain criteria during either of the two periods of the MIPS Eligibility Determination (October 1, 2021 – September 30, 2022, or October 1, 2022 – September 30, 2023).
The exclusion criteria include billing $90,000 or less in Medicare Part B charges, treating 200 or fewer Part B patients, or providing 200 or fewer covered services to Part B patients. Clinicians who meet all three of these criteria can choose to either report data for traditional MIPS voluntarily or if they are “opt-in eligible,“ they can choose to opt-in or report voluntarily.
MIPS Eligibility 2024 Status Check
As we move into 2024, clinicians should use the QPP Participation Status Tool to check their eligibility for MIPS. By entering their 10-digit National Provider Identifier (NPI), they can find out if they need to participate in MIPS for the 2024 performance year.
To be eligible for MIPS in 2024, clinicians must meet all of the following criteria, which include:
- Bill more than $90,000 for Medicare Part B services
- Provide care to more than 200 Medicare Part B patients
These services offer more than 200 covered professional services under the Medicare Physician Fee Schedule (PFS).
Options to Participate
Clinicians who don’t meet all three criteria for the 2024 performance year are excluded from MIPS Healthcare. However, they can choose to opt-in or voluntarily report to MIPS. Once they make this choice, it’s final and cannot be changed.
If you’re eligible to participate, you don’t have to participate in MIPS, but during the submission period, you can choose to opt-in and receive performance feedback and a MIPS payment adjustment (positive, negative, or neutral).
For those excluded from MIPS, there’s still the option to voluntarily report under traditional MIPS, but this won’t affect your MIPS payment adjustment.
Upcoming Changes and What to Expect
The QPP Participation Status Tool will be updated in December 2024 with the final eligibility details for the 2024 MIPS performance year. Updates about clinicians’ Qualifying APM Participant (QP) status are also expected three times during the year—in July, October, and December 2024.
Staying updated on MIPS eligibility and making smart participation choices can greatly impact clinicians’ reimbursements and the quality of care they provide. Regularly checking eligibility and understanding participation options will help clinicians manage the challenges of value-based care effectively.
Closing Point
Clinicians ought to be updated on MIPS eligibility and participation options so that they can stay in line with any healthcare changes that may follow. The QPP Participation Status Tool and all that entails for 2023 and 2024 will thus guide healthcare providers into wise decisions that shall affect their payments and the general operation of the practice.
Whether opting in or reporting voluntarily, clinicians must check their status periodically and prepare for whatever decisions may be made. The doctors need to stay updated on MIPS to ensure eligibility and provide better patient care through value-based systems.
If you want to participate in MIPS 2024 and need expert guidance for eligibility criteria, book a consultation with us right now!
