FAQ – MIPS

Question – MIPS Performance Year 2021

Is the MIPS payment adjustment applied before or after sequestration?

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Question – MIPS Performance Year 2021

Is the MIPS payment adjustment applied to the Medicare paid amount or Medicare allowed amount for each CPT code?

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Question – MIPS Performance Year 2021

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?

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Question – MIPS Performance Year 2021

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?

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Question – MIPS Performance Year 2021

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?

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Question – MIPS Performance Year 2021

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?

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Question – MIPS Performance Year 2021

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?

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Question – MIPS Performance Year 2021

In Performance Period 2021, how are quality measures scored?

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Question – MIPS Performance Year 2021

How is the 70% data completeness calculated?

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Question – MIPS Performance Year 2021

In Performance Year 2021, how many quality measures must physical therapists, occupational therapists and speech-language pathologists report?

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Question – MIPS Performance Year 2021

What is the definition of a small practice?

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Question – MIPS Performance Year 2021

For MIPS reporting in Performance Period 2021, how is a virtual group defined?

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Question – MIPS Performance Year 2021

For MIPS reporting in Performance Year 2021, how is a group defined?

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Question – MIPS Performance Year 2021

For MIPS reporting in Performance Year 2021, how is an individual defined?

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Question – MIPS Performance Year 2021

How can I participate in the MIPS program in 2021?

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Question – MIPS Performance Year 2021

What is the minimum score I need to achieve in 2021 to avoid a negative payment adjustment in 2023?

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Question – MIPS Performance Year 2021

What are the payment adjustments if I report successfully or unsuccessfully in the 2021 MIPS program?

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Question – MIPS Performance Year 2021

What if I do not exceed all 3 of the low-volume thresholds, can I opt-in to the MIPS program in 2021?

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Question – MIPS Performance Year 2021

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

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Question – MIPS Performance Year 2021

How is the > 200 unique Medicare beneficiaries calculated?

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Question – MIPS Performance Year 2021

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

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Question – MIPS Performance Year 2021

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?

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Question – MIPS Performance Year 2021

Is the low-volume threshold based on traditional Medicare Part B claims only or ALL claims?

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Question – MIPS Performance Year 2021

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?

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Question – MIPS Performance Year 2021

What is the determination period that CMS will use to see if an eligible clinician will be required to participate in MIPS in 2021?

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Question – MIPS Performance Year 2021

Does MIPS apply to rehabilitation agencies?

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Question – MIPS Performance Year 2021

Is there an easy way to know if I am a private practice with the Medicare program?

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Question – MIPS Performance Year 2021

What practice setting(s) does MIPS apply to in calendar year 2021?

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Question – MIPS Performance Year 2019

How will 2021 MIPS payment adjustments be reflected on remittance advice (RA) documents?

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Question

Is the MIPS payment adjustment applied to the Medicare paid amount or Medicare allowed amount for each CPT code?

Answer

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Question

Is the MIPS payment adjustment applied before or after sequestration?

Answer

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Question

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?

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Question

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?

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Question

In 2020, how are quality measures scored?

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Question

What are the payment adjustments if I report successfully or unsuccessfully in the 2020 MIPS program?

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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 2020?

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Question

How does CMS calculates the penalty for those choosing not to participate/report?

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Question

Regarding the Improvement Activities, how can we determine which Improvement Activities are considered high-weighted and which are considered medium-weighted?

Answer

Question

How do we go about opting in and when is the deadline?

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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?

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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?

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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?

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Question

Are the measures to be reported for the Initial Evaluation only or do you have to report them on every visit?

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Question

Are the quality categories only completed at the initial visit?

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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?

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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?

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Question

How often to you have to attest for Improvement Activities?

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Question

Please clarify how to report Improvement Activities and how often to report?

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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

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

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

Question

As a CORF, we bill using UB-04 claim form, can we opt-in?

Answer

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

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

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

Question

If we are mandated to participate in MIPS in 2019, do we start January 1, 2019?

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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?

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Question

When is the deadline to make a decision to opt in?

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Question

Can a Group report measures via claims?

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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

Question

In 2019, what outcome measures are available to physical and occupational therapists?

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Question

In 2019, what high priority measures are available to physical and occupational therapists?

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Question

In 2019, how can you submit quality measures to the Centers for Medicare and Medicaid Services?

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Question

In 2019, how are quality measures scored?

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Question

What is a topped out measure?

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Question

What is the minimum score I need to achieve in 2019 to avoid a negative payment adjustment in 2021?

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Question

How can I participate in the MIPS program in 2019?

Answer

Question

For MIPS reporting in 2019, how is an individual defined?

Answer

Question

For MIPS reporting in 2019, how is a group defined?

Answer

Question

For MIPS reporting in 2019, how is a virtual group defined?

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Question

What are the 4 performance categories in the MIPS program?

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Question

In 2019, how can physical therapists, occupational therapists and speech-language pathologists report quality measures to CMS?

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Question

What is the definition of a small practice?

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Question

In 2019, how many quality measures must physical therapists, occupational therapists and speech-language pathologists report?

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Question

How is the 60% completeness defined?

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Question

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

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Question

What is a MIPS eligible clinician?

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Question

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

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Question

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

Answer

Question

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

Answer

Question

How is the > 200 unique Medicare beneficiaries calculated?

Answer

Question

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

Answer

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

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

Question

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

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Question

What does MIPS stand for?

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Question

What did MIPS replace?

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Question

When did MIPS start?

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Question

What practice settings does MIPS apply to?

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Question

In calendar years 2017 and 2018, could physical therapists, occupational therapists and speech-language pathologists in private practice participate in MIPS?

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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?

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Question

What are the 4 performance categories for the MIPS program?

Answer