As you navigate changes in your professional journey, it's crucial to stay informed about your MIPS Eligibility status. Checking the Quality Payment Program (QPP) Status Tool for the 2023 performance year and your initial 2024 status can provide valuable insights into any modifications to your eligibility.

Why Check Your Final 2023 Eligibility?

From October 1, 2022 to September 30, 2023, CMS conducted the second segment of MIPS Eligibility status determination. This involved a thorough review of your Medicare Part B claims and Medicare Provider Enrollment, Chain, and Ownership System (PECOS) data.

Following the third snapshot of Alternative Payment Model (APM) data, which considered Medicare Part B claims from January 1, 2023 to August 31, 2023, the QPP Status Tool was updated on December 8, 2023. Changes included updates to Qualifying APM Participant (QP) status and MIPS APM participation status.

APM Participation undergoes four reviews throughout the year, covering the first 3 months, first 6 months, 8 months, and the full performance year (January 1, 2023 to December 31, 2023). Changes in your MIPS eligibility status can impact payment adjustments, making it essential to stay updated.

Please note that eligibility changes may stem from the initial determination period in Segment 1. Here's a breakdown: · MIPS Eligible in the First Segment: Your status might have changed, you may be ineligible. The QPP Status Tool is a valuable resource for confirming this. · Not Eligible in a Specific Practice: If your initial determination pronounced you ineligible at a specific practice, your eligibility status for that practice remains unchanged.

For those who joined a new practice between October 1, 2022 and September 30, 2023, MIPS eligibility is evaluated based on the association with the new practice (identified by TIN) during the second review.

If you joined a new practice after September 30, 2023, individual MIPS eligibility is not applicable based on the association with the new practice (identified by TIN). However, you might be eligible for a MIPS payment adjustment if the new practice chooses to participate in MIPS as a group.

How Was My Initial 2024 MIPS Eligibility Status Determined?

For eligibility to participate in MIPS in 2024, you must:

1. Bill more than $90,000 annually in allowable charges for covered professional services under the Medicare Physician Fee Schedule (PFS).
2. Furnish covered professional services to more than 200 Medicare Part B beneficiaries.
3. Provide more than 200 covered professional services under the PFS.

If you do not to meet all three criteria you may be excluded from MIPS reporting. However, you have the option to opt in and receive a payment adjustment if you meet or exceed one or two, but not all, of the low-volume threshold criteria. Alternatively, voluntary reporting to MIPS is an option without receiving a payment adjustment if you don't meet any or only some of the criteria.

It's important to note that the low-volume threshold for MIPS Alternative Payment Model (APM) participants is evaluated at the individual or group level, mirroring the assessment for participants not in a MIPS APM. Stay informed by experts from Quantician to make the most of MIPS opportunities for the 2024 performance year.