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MIPS Questions and Answers: Part 1

by • December 3, 2018 • 8 Comments

The Merit-Based Incentive Payment System (MIPS) in 2019 will now include physical therapists, occupational therapists and speech-language pathologists that treat Medicare beneficiaries in the private practice setting. The simplest way to know if you are a private practice under the Medicare program is that you submit claims to your Medicare Administrative Contractor on a 1500-claim form. Over the next several weeks, I will be answering question I receive on the MIPS program to help you get prepared. In addition, I will be presenting a 2.5 hour MIPS webinar on December 18, 2018 from 1:00pm – 3:30pm ET. For additional information on this webinar and to register, click HERE.

Question

In calendar year 2019, what professionals will be considered an eligible clinician for MIPS?

Answer

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Question

What is a MIPS eligible clinician?

Answer

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Question

How will I know if I will be required to participate in MIPS in 2019?

Answer

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Question

In 2019, what are the 3 low-volume thresholds?

Answer

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Question

How is the $90,000 in Medicare Part B allowed charges calculated?

Answer

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Question

How is the > 200 unique Medicare beneficiaries calculated?

Answer

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Question

How is the > 200 covered professional services under the Medicare Physician Fee Schedule?

Answer

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Question

What is the determination period that CMS will use to see if an eligible clinician will be required to participate in MIPS in 2019?

Answer

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Question

What if I do not exceed all 3 of the low-volume thresholds, can I opt-in to the MIPS program in 2019?

Answer

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Question

What are the payment adjustments if I report successfully or unsuccessfully in the 2019 MIPS program?

Answer

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I hope you enjoyed Part 1 of MIPS FAQs. Watch for Part 2 MIPS FAQs to be released next week. Thank you for being a Gold Member!

8 thoughts on “MIPS Questions and Answers: Part 1”

  1. Don Oliver says:

    What is the accurate way to document MIPS so that I can get payment for doing so? Is the correct way to just follow the template for MIPS and fill in the bubbles ? Or is there a right/wrong way?
    I know on PQRS several years ago I did what I thought were correct steps but somehow didn’t meet the requirements and ended up getting less payment
    I would like to know the right way to do it so I am rewarded

    Thanks

    1. Rick Gawenda says:

      My advice is to listen to my webinar on December 18th from 1:00pm -3:30pm ET. That will give you the most detail.

  2. John Hamil says:

    “The simplest way to know if you are a private practice under the Medicare program is that you submit claims to your Medicare Administrative Contractor on a 1500-claim form”
    We are a Part B provider and file on a UB04 form, will this still include us?

    1. Rick Gawenda says:

      Since you do not bill on a 1500-claim form, no.

  3. Danielle says:

    Hi Rick…thanks for the article…what about the scenario if you don’t meet the 3 criteria in the first period…stay in the same practice…and then meet all three in the second period…do you have to report MIPS?

    1. Rick Gawenda says:

      In the scenario you describe, no.

  4. Mike Rantissi says:

    Based on the 2018 MIPS numbers, none of our providers exceed all three low-volume thresholds. They exceed 2 of the 3. For this reason, we were planning on gathering more information before we decide to opt-in. However, when will we officially get the list for providers required in 2019? I’ve been told that Medicare isn’t going to release the list until March for the first determination period. Is this correct? What happens if you chosen not to opt in based on info you have, and then the list comes out and you were actually above all three low-volume thresholds?
    We are currently signed up for the Dec 18 webinar, but I’m being proactive.

    1. Rick Gawenda says:

      CMS will not release the first determination period data until the first quarter of 2019. This may be one reason to report via registry and I will discuss this on December 18th during the webinar.

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