The Merit-Based Incentive Payment System (MIPS) reporting works under Quality Payment Program (QPP). It was formed in 2017 to move Medicare part B providers towards a performance-based payment system.
Medical Practitioners Who Are Eligible for MIPS 2021
The practitioners that are eligible for participation in MIPS 2021 reporting and meet the Low-Volume Threshold (LVT) of Medicare part B Billing or Critical Access Hospital Method II payments assigned to CAH are:
- Physicians (DDS, DPM, DDM, MD/DO, Chiropractors, and Optometrists)
- Physician Assistants
- Clinical Psychologists
- Nurse Practitioners
- Certified/Registered Nurse Anesthetists
- Physical or Occupational Therapists
- Dieticians/Nutritional Professionals
- Speech and Language Therapists
- Clinical Nurse Specialists
Special Status Designations
Special status designations are specific conditions that are assigned to participants according to their MIPS 2021 eligibility status.
There are different designations for different participants, for instance, individuals, groups, virtual groups, and APM entities. And those who qualify are allowed reweighing or submission of fewer activities per category.
Types of Clinicians Who Receive Special Statuses
- Working in rural areas
- Hospital-based clinicians
- Small practices
- Non-patient facing healthcare providers
- Health Professional Shortage Area (HPSA)
- Ambulatory Surgery Center (ASC)-based clinicians
Ambulatory Surgery Center (ASC)-based
- MIPS 2021 clinicians, who report individually, are eligible for this position if they provide at least 75% or more of their professional services in places found under Place Of Service (POS) code 24.
- A group or a virtual group is eligible for this category if 100% of their participating clinicians are ASC-based.
- If you qualify as ASC-based, you can automatically get your Promoting Interoperability (PI) category reweighted for MIPS 2021 data submission. Its 25% will be redistributed among other performance categories unless you submit data for it.
- As an individual clinician, you qualify for this category if you provide 75% or more of your covered professional services in places listed under Place Of Service (POS). Specifically on-campus outpatient hospitals, inpatient hospitals, off-campus outpatient hospitals, or emergency rooms.
- A group can qualify for this category if 75% or more of its clinicians billing under the same TIN come under the hospital-based category.
- A virtual group can qualify for this category if 75% or more of the participants come under the hospital-based category.
If you qualify as hospital-based, you can automatically get your Promoting Interoperability (PI) category reweighted. Its 25% will get redistributed in other performance categories if no data gets submitted for it.
- You are eligible for this category if you, as an individual, had 100 or fewer Medicare Part B patient encounters in the reporting year. That includes telehealth services as well.
- A group or a virtual group is eligible for this category at the TIN level if 75% or more of their billing clinicians are considered non-patient facing.
If you qualify as non-patient-facing, you can automatically get your Promoting Interoperability (PI) category reweighted for MIPS 2021 reporting. Unless data gets submitted for it, its 25% will get redistributed among other performance categories.
Usually, anesthesiologists are the ones that qualify for this category the most, as they have been deemed as non-patient-facing by the CMS.
- Individual clinicians will receive this designation if they are one of 15 or fewer clinicians billing under the practice’s TIN.
- A group or a virtual group is eligible for this category if 15 or less of their clinicians are billing under the same practice’s TIN.
- An APM Entity can qualify for this category if there are 15 or fewer clinicians associated with them.
Eligibility in this category will give you twice the points (2X) for each improvement activity you submit in MIPS 2021 reporting. In addition to this, if you submit a MIPS quality measure, you will get six bonus points in the quality performance category. Small practices can also get three points for submitting quality measures that do not meet the completeness criteria.
Health Professional Shortage Area (HPSA)
- If you are a MIPS-eligible clinician practicing in an HPSA-designated area, you can qualify for this category.
- A group or virtual group will qualify for this category if 75% or more of their billing clinicians are in an area designated as an HPSA. Also, only a group with at least one practice site under an HPSA-designated TIN can receive this status as well.
All the eligible candidates will receive two times (2X) the points for each improvement activity they submit.
- You, as a clinician, are eligible if the area you work in has been designated as rural by the Federal Office of Rural Health Policy (FORHP). Meaning its ZIP code comes under the rural category in the most recent FORHP Eligible ZIP Code File.
- A group is eligible for this category only if 75% or more of its participants bill under a practice with the same TIN. It should also be in an area under the rural category in the most recent FORHP Eligible ZIP Code File available.
- For a virtual group, it is only possible when 75% or more of the billing participants come under the rural category in the most recent FORHP Eligible ZIP Code File.
All these MIPS 2021 eligible clinicians will receive twice (2X) the points for each submitted improvement activity.