Question – MIPS Performance Year 2021
Is the MIPS payment adjustment applied before or after sequestration?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
Is the MIPS payment adjustment applied to the Medicare paid amount or Medicare allowed amount for each CPT code?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
When considering a small practice, are PTAs, OTA’s, part-time or PRN employees considered in the number of clinicians greater or less than 15?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
If a physical therapist (PT), occupational therapist (OT) and/or speech-language pathologist (SLP) participates in MIPS in Performance Year 2021 and scores below the minimal Performance Threshold Score and now will receive a negative payment adjustment in 2023, they leave this practice and begin work at another private practice, does this negative payment adjustment follow them to their new practice?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
If a therapist works in 2 or more different private practices and all 3 low-volume thresholds are exceeded when adding the 3 low-volume thresholds from all of the clinics together against the therapist’s NPI, would they be required to participate in MIPS at all of their private practices?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
Please clarify group under one TIN. Lets say we have 10 NPIs (all physical therapists) who all reassign their payments to one TIN and the total of these 10 exceed all three threshold’s. Does this then make it mandatory to participate in MIPS in Performance Year 2021?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
We are considered a group as we all bill under the same TIN. However, each individual NPI (clinician) does not exceed all 3 of the low-volume threshold’s during both determination periods. Are we required to participate as a group?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
In Performance Period 2021, how are quality measures scored?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
How is the 70% data completeness calculated?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
In Performance Year 2021, how many quality measures must physical therapists, occupational therapists and speech-language pathologists report?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
What is the definition of a small practice?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
For MIPS reporting in Performance Period 2021, how is a virtual group defined?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
For MIPS reporting in Performance Year 2021, how is a group defined?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
For MIPS reporting in Performance Year 2021, how is an individual defined?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
How can I participate in the MIPS program in 2021?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
What is the minimum score I need to achieve in 2021 to avoid a negative payment adjustment in 2023?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
What are the payment adjustments if I report successfully or unsuccessfully in the 2021 MIPS program?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
What if I do not exceed all 3 of the low-volume thresholds, can I opt-in to the MIPS program in 2021?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
How is the > 200 covered professional services determined under the Medicare Physician Fee Schedule?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
How is the > 200 unique Medicare beneficiaries calculated?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
How is the $90,000 in Medicare Part B allowed charges calculated?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
For Performance Year 2021, is there a way for me to check right now if I did exceed all 3 of the low-volume thresholds during the first determination period?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
Is the low-volume threshold based on traditional Medicare Part B claims only or ALL claims?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
What are the 3 low-volume thresholds, that if exceeded during both determination periods, would require the MIPS eligible clinician participate in MIPS in Performance Period 2021?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
What is the determination period that CMS will use to see if an eligible clinician will be required to participate in MIPS in 2021?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
Does MIPS apply to rehabilitation agencies?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
Is there an easy way to know if I am a private practice with the Medicare program?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2021
This content is for Gold Members only. Please log in above or Register
What practice setting(s) does MIPS apply to in calendar year 2021?
AnswerThis content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2019
This content is for Gold Members only. Please log in above or Register
How will 2021 MIPS payment adjustments be reflected on remittance advice (RA) documents?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
Is the MIPS payment adjustment applied to the Medicare paid amount or Medicare allowed amount for each CPT code?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
Is the MIPS payment adjustment applied before or after sequestration?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
What if a therapist who received multiple MIPS scores in Performance Year 2019 resulting in different payment adjustments for the practices they are working at that will affect the 2021 Payment Period now begins practicing at a new private practice in calendar year 2021, which payment adjustment follows them to this new NPI/TIN combination?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
Is it possible for a therapist who has their own individual NPI number and is employed or contracted by multiple private practices (different TINs) to have different scores and subsequently, different payment adjustments for each practice they are employed at?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
In 2020, how are quality measures scored?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
What are the payment adjustments if I report successfully or unsuccessfully in the 2020 MIPS program?
Answer This content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
What is the determination period that CMS will use to see if an eligible clinician will be required to participate in MIPS in 2020?
Answer This content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
How does CMS calculates the penalty for those choosing not to participate/report?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
Regarding the Improvement Activities, how can we determine which Improvement Activities are considered high-weighted and which are considered medium-weighted?
Answer
This content is for Gold Members only. Please log in above or Register
Question
How do we go about opting in and when is the deadline?
Answer
This content is for Gold Members only. Please log in above or Register
Question
If we have 11 therapists and 7 physicians but all therapy billing is incident to the physician, are we classified as a small practice since we only have 7 physicians?
Answer
This content is for Gold Members only. Please log in above or Register
Question
If we are excluded from MIPS, do not want to opt-in to MIPS and we submit via claims, is there anything special we need to do?
Answer
This content is for Gold Members only. Please log in above or Register
Question
If we are a small group private practice who is NOT required to participate, but eligible, will we be penalized if we do not participate?
Answer
This content is for Gold Members only. Please log in above or Register
Question
Are the measures to be reported for the Initial Evaluation only or do you have to report them on every visit?
Answer
This content is for Gold Members only. Please log in above or Register
Question
Are the quality categories only completed at the initial visit?
Answer
This content is for Gold Members only. Please log in above or Register
Question
Our EHR says that due to MIPS every one of our patients must do a functional outcome test every 30 days. They will be reporting through a registry for us. Is this correct or just a rule they are putting in place on their own?
Answer
This content is for Gold Members only. Please log in above or Register
Question
As a small practice, if we don’t meet the criteria to be apart of MIPS, would we no longer get a Medicare payment increase?
Answer
This content is for Gold Members only. Please log in above or Register
Question
How often to you have to attest for Improvement Activities?
Answer
This content is for Gold Members only. Please log in above or Register
Question
Please clarify how to report Improvement Activities and how often to report?
Answer
This content is for Gold Members only. Please log in above or Register
Question
When determining the > $90,000 in Medicare allowed charges, is this the amount we bill Medicare or is it the amount that Medicare actually paid us?
Answer
This content is for Gold Members only. Please log in above or Register
Question
When considering a small practice, are PTAs, OTA’s, part-time or PRN employees considered in the number of clinicians greater or less than 15?
Answer
This content is for Gold Members only. Please log in above or Register
Question
We have a small practice with 4 physical therapists who have all reassigned their benefits to the group TIN. Individually, each therapist does not exceed all 3 low-volume thresholds requiring them to participate in MIPS in 2019. However, their combined group data does meet the criteria. So do we have to opt in as a group?
Answer
This content is for Gold Members only. Please log in above or Register
Question
As a CORF, we bill using UB-04 claim form, can we opt-in?
Answer
This content is for Gold Members only. Please log in above or Register
Question
Please clarify group under one TIN. Lets say we have 10 NPIs who all reassign their payments to one TIN and the total of these 10 exceed all three threshold’s. Does this then make it mandatory to participate in MIPS?
Answer
This content is for Gold Members only. Please log in above or Register
Question
We are considered a group as we all bill under the same TIN. However, each individual NPI (clinician) does not exceed all 3 of the low-volume threshold’s. Are we required to participate as a group?
Answer
This content is for Gold Members only. Please log in above or Register
Question
If a therapist works 2 or private practices, and all 3 low-volume thresholds would be exceeded when tracking against the therapist’s NPI, would they have to participate in MIPS at all of their private practices?
Answer
This content is for Gold Members only. Please log in above or Register
Question
If we are mandated to participate in MIPS in 2019, do we start January 1, 2019?
Answer
This content is for Gold Members only. Please log in above or Register
Question
If we are going to opt out, is there a process you need to go through ? Do you need to opt out on the CMS website?
Answer
This content is for Gold Members only. Please log in above or Register
Question
When is the deadline to make a decision to opt in?
Answer
This content is for Gold Members only. Please log in above or Register
Question
Can a Group report measures via claims?
Answer
This content is for Gold Members only. Please log in above or Register
Question
If a group opts in and successfully or unsuccessfully participates in MIPS in 2019, does the positive or negative payment adjustment follow an individual if they switch to a different private practice in 2021?
Answer
This content is for Gold Members only. Please log in above or Register
Question
In 2019, what outcome measures are available to physical and occupational therapists?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
In 2019, what high priority measures are available to physical and occupational therapists?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
In 2019, how can you submit quality measures to the Centers for Medicare and Medicaid Services?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
In 2019, how are quality measures scored?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
What is a topped out measure?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
What is the minimum score I need to achieve in 2019 to avoid a negative payment adjustment in 2021?
AnswerThis content is for Gold Members only. Please log in above or Register
Question
This content is for Gold Members only. Please log in above or Register
How can I participate in the MIPS program in 2019?
Answer
This content is for Gold Members only. Please log in above or Register
Question
For MIPS reporting in 2019, how is an individual defined?
Answer
This content is for Gold Members only. Please log in above or Register
Question
For MIPS reporting in 2019, how is a group defined?
Answer
This content is for Gold Members only. Please log in above or Register
Question
For MIPS reporting in 2019, how is a virtual group defined?
Answer
This content is for Gold Members only. Please log in above or Register
Question
What are the 4 performance categories in the MIPS program?
Answer
This content is for Gold Members only. Please log in above or Register
Question
In 2019, how can physical therapists, occupational therapists and speech-language pathologists report quality measures to CMS?
Answer
This content is for Gold Members only. Please log in above or Register
Question
What is the definition of a small practice?
Answer
This content is for Gold Members only. Please log in above or Register
Question
In 2019, how many quality measures must physical therapists, occupational therapists and speech-language pathologists report?
Answer
This content is for Gold Members only. Please log in above or Register
Question
How is the 60% completeness defined?
Answer
This content is for Gold Members only. Please log in above or Register
Question
In calendar year 2019, what professionals will be considered an eligible clinician for MIPS?
Answer
This content is for Gold Members only. Please log in above or Register
Question
What is a MIPS eligible clinician?
Answer
This content is for Gold Members only. Please log in above or Register
Question
How will I know if I will be required to participate in MIPS in 2019?
Answer
This content is for Gold Members only. Please log in above or Register
Question
In 2019, what are the 3 low-volume thresholds?
Answer
This content is for Gold Members only. Please log in above or Register
Question
How is the $90,000 in Medicare Part B allowed charges calculated?
Answer
This content is for Gold Members only. Please log in above or Register
Question
How is the > 200 unique Medicare beneficiaries calculated?
Answer
This content is for Gold Members only. Please log in above or Register
Question
How is the > 200 covered professional services under the Medicare Physician Fee Schedule?
Answer
This content is for Gold Members only. Please log in above or Register
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
This content is for Gold Members only. Please log in above or Register
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
This content is for Gold Members only. Please log in above or Register
Question
What are the payment adjustments if I report successfully or unsuccessfully in the 2019 MIPS program?
Answer
This content is for Gold Members only. Please log in above or Register
Question
What does MIPS stand for?
Answer
This content is for Gold Members only. Please log in above or Register
Question
What did MIPS replace?
Answer
This content is for Gold Members only. Please log in above or Register
Question
When did MIPS start?
Answer
This content is for Gold Members only. Please log in above or Register
Question
What practice settings does MIPS apply to?
Answer
This content is for Gold Members only. Please log in above or Register
Question
In calendar years 2017 and 2018, could physical therapists, occupational therapists and speech-language pathologists in private practice participate in MIPS?
Answer
This content is for Gold Members only. Please log in above or Register
Question – MIPS Performance Year 2019
For calendar year 2019, is the Centers for Medicare and Medicaid Services (CMS) considering adding physical therapists and occupational therapists in private practice as eligible MIPS clinicians?
Answer
This content is for Gold Members only. Please log in above or Register
Question
What are the 4 performance categories for the MIPS program?
Answer
This content is for Gold Members only. Please log in above or Register