Are You MIPS Exempt? Word Coming Soon

Physicians, check your mailboxes to find out whether you are eligible or exempt from the Merit-Based Incentive Payment System (MIPS) for the 2017 performance period and what that may mean for your 2019 Medicare payment rates.

The Centers for Medicare & Medicaid Services (CMS) has begun sending letters to individual and group practices that say which clinicians associated with a taxpayer identification number are eligible for the program and which are exempt. The 2017 performance period began Jan. 1.

MIPS is one of two payment paths under the new CMS Quality Payment Program, which is part of the Medicare Access and CHIP Reauthorization Act (MACRA). It replaces the Sustainable Growth Rate formula and consolidates the Physician Quality Reporting System, the Value-Based Payment Modifier program, and Medicare's electronic health records incentive (meaningful use) program into one single program this year. 

In 2017, CMS will exempt physicians from MIPS if they: 

  • Are in their first year of Medicare Part B participation;
  • Are part of an advanced alternative payment model; or 
  • Care for 100 or fewer Medicare Part B patients or bill Medicare less than $30,000 in Part B-allowed charges each year.  

CMS estimates that about 41 percent of clinicians will be exempt from participating in MIPS in 2017. "Eligible clinicians in small practices are much more likely to be excluded from MIPS than those in larger practices," CMS says. "For example, more than half (51.6 percent) of eligible clinicians in practices of one to nine clinicians will be excluded from MIPS, whereas about one-fourth (27.3 percent) of eligible clinicians in practices of 100 or more clinicians will be excluded."

For questions about your eligibility and exemption status or other information in your letter, contact the CMS Quality Payment Program Service Center by phone at (866) 288-8292 or by email. If you are not exempt from MIPS, you can turn to TMA and the TMF Health Quality Institute for help.  

  • For information about your participation options and simplest ways to avoid the 2019 MIPS penalty, refer to this Action article
  • For MACRA education, attend the education tracks on Quality Payment Programs in Today's Practice, May 5-6 at TexMed 2017, hosted by the TMA Councils on Health Care Quality and Practice Management Services. Registration is free for TMA members. 
  • For a MACRA readiness assessment and customized on-site assistance to help you with your practice's specific needs, contact TMA Practice Consulting by phone at (800) 523-8776 or by email. The assessment will focus on clinical processes, electronic health record optimization, and workflow improvement opportunities to help increase your MIPS scoring. TMA is dedicated to working with you and your practice to earn an incentive payment, not just avoid the penalty.  
  • For MIPS education and technical assistance, join the TMF Quality Payment Program Network or contact TMF by email.  

For more information, visit the TMA MACRA Resource Center

Action, May 1, 2017

Last Updated On

April 28, 2017

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