2019 MIPS eligibility tool has been updated!  

CMS has finally updated the “look-up tool” for 2019 MIPS so providers may find out if they are eligible and also see what reporting options are available to them this year.

Similar to 2018, there will be no letter from CMS letting you know whether you have to report.  Again this year, the burden falls on you to determine eligibility status on the CMS website and interpret your findings.  There is a lot to interpret this year and making sense of your eligibility listing can be tricky.  Patient360 is happy to assist you with this process! Please contact us!

Good News: There is tremendous flexibility this year if you are not a Required Participant.  Which begs the question: Who is a Required Participant and who gets to choose? So glad you asked!

As in years past, it is essential to understand Low Volume Thresholds (LVT) which afford providers with too little Medicare volume to opt out of MIPS without penalty.  In 2019, there are a total of three (3) LVTs:

1.     Providers seeing less than 200 Medicare Part B patients.

2.     Providers with less than $90,000 in total Medicare Part B charges.

3.     Providers with fewer than 200 covered professional services to Medicare Part B patients.

If you or your practice exceeds the LVTs, you are a Required Participant and must report or be financially penalized. If one or more of the LVTs are applicable to your practice, you have some GREAT options to participate:

2019 MIPS Participation Options 

Opt-In:  If you exceed 1 or 2, (but not 3) you can report through “Opt-In” (i.e., the middle option, above).  Please know when opting in you are now considered an Eligible Clinician and subject to payment adjustment; i.e., positive, neutral, or negative payment adjustments.  So, if you’re gonna go for it, then really put your all in! Once you opt-in, you’re in. Your decision cannot be altered for the current reporting year. P360 suggests you wait and see how data is looking throughout the year in the Patient360 portal! You don’t formally “Opt In” until you decide to submit your data to CMS/Medicare.

Voluntarily Report: If you aren’t required to report and want to better understand the program by tracking some measures and activities, you can Voluntarily Report [data to] MIPS. You won’t be subject to positive or negative payment adjustments but you can still improve processes and learn about MIPS. You are able to receive a MIPS score but (again) you will not be subject to a payment adjustment. This is a great opportunity to get your feet wet, test out workflows, and make adjustments to clinical behavior to ready yourself for future years.

Non Participation: If you aren’t required to report MIPS, and you don’t feel like diving in, no worries as there is no obligation. However, if you anticipate being an eligible provider in the future it makes sense to minimally use the Voluntarily Report option to learn before penalties reach 9% in 2020.

MIPS 2019 Wireframe 1MIPS 2019 Wireframe 2

(Source: CMS Wireframe Drawings)

MIPS is here to stay.  Working with a Registry such as Patient360 to report, either as an Eligible Clinician, an Opt-In Participant, or as a Voluntary Participant, will allow your practice to have the opportunity to access the most quality measures available – those that apply to your practice and your patients.

Questions?  Please contact us.  Sales@patient360.com