{"id":880,"date":"2016-11-08T07:00:35","date_gmt":"2016-11-08T14:00:35","guid":{"rendered":"https:\/\/dsiohn098w.mpqhf.org\/blog\/?p=880"},"modified":"2017-04-03T11:59:22","modified_gmt":"2017-04-03T17:59:22","slug":"880-2","status":"publish","type":"post","link":"https:\/\/dsiohn098w.mpqhf.org\/blog\/880-2\/","title":{"rendered":"MIPS: Eligibility and the Low Volume Threshold \u2013 What to Consider Now"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2016\/11\/Eligibility-Low-Volume-Threshold-11.07.2016.png\" alt=\"Eligibility-&amp;-Low-Volume-Threshold-11.07.2016\" width=\"1200\" height=\"300\" class=\"alignnone size-full wp-image-885\" srcset=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2016\/11\/Eligibility-Low-Volume-Threshold-11.07.2016.png 1200w, https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2016\/11\/Eligibility-Low-Volume-Threshold-11.07.2016-300x75.png 300w, https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2016\/11\/Eligibility-Low-Volume-Threshold-11.07.2016-768x192.png 768w, https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2016\/11\/Eligibility-Low-Volume-Threshold-11.07.2016-1024x256.png 1024w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/><\/p>\n<h1>MIPS: Eligibility and the Low Volume Threshold \u2013 What to Consider Now<\/h1>\n<h5>November 8, 2016<\/h5>\n<h6>Written by Sarah Leake<\/h6>\n<p>Let\u2019s revisit Eligibility &#8211;<\/p>\n<p>The following clinicians are considered eligible clinicians for the 2017 performance year &#8211;<\/p>\n<ul>\n<li>(MD\/DO and DMD\/DDS), Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists<\/li>\n<li>Only those eligible clinicians in the categories above who bill for Medicare Part B (otherwise known as the Physician Fee Schedule) \u2013 including those billing using Critical Access Hospital (CAH) Method II payment methodology who have assigned their billing rights to the CAH<\/li>\n<li><strong>Excluded from MIPS payment adjustments:<\/strong>\u00a0Payments from Medicare Part A, Medicare Advantage Part C, Medicare Part D, FQHC or Rural Health Clinic facility payments billed under all-inclusive payment methodologies, and CAH Method I <em>facility<\/em> payments<\/li>\n<\/ul>\n<p>CMS has set exemptions for \u201celigible clinicians\u201d in the MIPS side of the Quality Payment Program which I have listed later in this blog.\u00a0 One in particular is the <em>low volume threshold<\/em> that can be applied at a provider or at a group level.\u00a0 Low volume thresholds are stated to determine if you <em><strong><u>will be<\/u><\/strong><\/em> participating as defined by CMS.<em> \u201cClinicians exempt from MIPS do not meet the threshold to participate if they have \u2264 $30,000 in allowed Medicare charges <strong>OR<\/strong> \u2264 100 Medicare patients.\u201d\u00a0 <\/em>Remember though, if you pick the group level for reporting, then all providers under that TIN will need to report at the group level. \u201c<\/p>\n<p>If you find that a clinician falls into the \u201cnot eligible\u201d category due to low volume threshold, you may still choose to continue to monitor to align with your quality program, but this clinician will not be considered for payment adjustments in terms of reductions or incentives for the 2017 participation year.\u00a0 It is important to review your organization\u2019s value based care strategy and financial situation to determine if \u201cself participation\u201d in the QPP program will fall into your goals and prepare you for future requirements and eligibility in reporting.<\/p>\n<p>The 2017 QPP year is definitely flexible and not a \u201cone size fits all\u201d program so requires your analysis to determine your participation goals and plans.<\/p>\n<p><strong>Resource Links and Other Information<\/strong><\/p>\n<p><em>Here are the Exemptions from MIPS &#8211;<\/em><\/p>\n<p>For the CY2017 performance year, there are three exemptions from MIPS for clinicians who otherwise meet the eligibility requirements &#8211;<\/p>\n<ul>\n<ul>\n<li>Clinicians in their first year of Medicare Part B participation<\/li>\n<li>Clinicians billing Medicare Part B up to $30,000 in allowed charges or providing care for up to 100 Part B patients in one year<\/li>\n<\/ul>\n<\/ul>\n<ul>\n<li><i>Clinicians in entities sufficiently participating in an\u00a0<a href=\"http:\/\/www.saignite.com\/resources\/faq-about-merit-based-incentive-payment-mips?_ga=1.229919386.708501024.1477941161#MIPS_What_is_an_Advanced_APM\" target=\"_blank\">Advanced APM<\/a>\u00a0 If you fall into this category please check the <a href=\"https:\/\/qpp.cms.gov\/\" target=\"_blank\">Quality Payment Program<\/a> website for more detail.<\/i><\/li>\n<\/ul>\n<p>Leave a reply, ask a question or share information using the \u201cLeave a Reply\u201d section below, or email <a href=\"mailto:sleake@mpqhf.org?subject=MACRA%20Blog%20Website\" target=\"_blank\">Sarah Leake<\/a> directly with your questions or comments.<\/p>\n<p><a href=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/macra\/\" target=\"_blank\">Read all previous posts<\/a><br \/>\n<a href=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/pqrs\/\" target=\"_blank\">See PQRS Blog<\/a><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><strong>Subscribe to the Merit-Based Incentive Payment System (MIPS) Blog<\/strong><br \/>\n<a href=\"http:\/\/eepurl.com\/ckIdME\" class=\"su-button su-button-style-flat\" style=\"color:#ffffff;background-color:#385173;border-color:#2d415c;border-radius:5px\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"color:#ffffff;padding:0px 30px;font-size:22px;line-height:44px;border-color:#74869d;border-radius:5px;text-shadow:0px 0px 0px #f4f4f4\"> Subscribe<\/span><\/a>\n<p>&nbsp;<\/p>\n<hr \/>\n<div id=\"boxzero\">\n<section id=\"boxone\">\n<p id=\"boxparagraph\"><strong>See a list of upcoming webinars<\/strong><\/p>\n<p><a href=\"http:\/\/www.mpqhf.org\/corporate\/health-and-technology-services\/upcoming-webinars\/\"><span class=\"link-spanner\">See a list of upcoming webinars<\/span><\/a><\/p>\n<\/section>\n<section id=\"boxtwo\">\n<p id=\"boxparagraph\"><strong>Check out any webinars you missed<\/strong><\/p>\n<p><a href=\"http:\/\/www.mpqhf.org\/corporate\/health-and-technology-services\/webinar-materials\/\"><span class=\"link-spanner\">Check out any webinars you missed<\/span><\/a><\/p>\n<\/section>\n<aside id=\"boxthree\">\n<p id=\"boxparagraph\"><strong>See our MIPS resources<\/strong><\/p>\n<p><a href=\"http:\/\/www.mpqhf.org\/corporate\/health-and-technology-services\/macra-quality-payment-program\/\"><span class=\"link-spanner\">See our MIPS resources<\/span><\/a><\/p>\n<\/aside>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>MIPS: Eligibility and the Low Volume Threshold \u2013 What to Consider Now November 8, 2016 Written by Sarah Leake Let\u2019s revisit Eligibility &#8211; The following clinicians are considered eligible clinicians for the 2017 performance year &#8211; (MD\/DO and DMD\/DDS), Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists Only those eligible clinicians [&hellip;]<\/p>\n","protected":false},"author":13,"featured_media":743,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[115],"tags":[123,116,23,124],"class_list":{"0":"post-880","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-quality-payment-program","8":"tag-advanced-apm","9":"tag-macra-qpp","10":"tag-mips","11":"tag-quality-payment-program","12":"entry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>MIPS: Eligibility and the Low Volume Threshold \u2013 What to Consider Now - Mountain Pacific Blog<\/title>\n<meta name=\"robots\" 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