Am I a MIPS Eligible Clinician for MIPS Reporting 2023?

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The Center for Medicare and Medicaid Services made subsequent changes in the MIPS program every year. This happens due to persistent changes in MIPS policies as a whole. Therefore, a responsible clinician must be aware of all of them before time. QPP has updated its MIPS-eligible clinician types information. The requirements for a specific clinician type to get MIPS eligibility however vary among different participation types. This makes a confusing situation and a clinician might think about whether I have MIPS reporting eligibility or not.

Here in this blog, we will sort out this problem for all such clinicians. Whether you are deciding to report as an individual, as part of a group, or as part of a virtual group, this blog is equally helpful for all. We will tell you how you can become a MIPS-eligible clinician.

CMS-Finalized MIPS Eligible Clinician Types 

Mentioned below is the list of all eligible clinician types for QPP MIPS reporting in 2023. Anyhow, these types also have to fulfill a set of requirements mandated by CMS. We will be shortly discussing these requirements ahead. But first, let’s have a sight of finalized eligible clinician types:

  • Physicians, including;
    • Doctors of medicine (M.D.s)
    • Osteopaths (D.O.s)
    • Dental surgeons (DDSs)
    • Doctors of Dental medicine (DMDs)
    • Podiatrists (DPMs)
    • Optometrists
  • Osteopathic practitioners
  • Chiropractors
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified nurse anesthetists
  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Qualified audiologists
  • Clinical social workers
  • Certified nurse midwives
  • Qualified speech-language pathologists/therapists
  • Registered dietitians or nutrition professionals

When you gain MIPS Eligibility as an Individual

A MIPS-eligible clinician must have identification as an eligible clinician type on Medicare Part B claims. Further, you must get enrollment in the MIPS program before the commencement of PY 2023 of MIPS. Make sure you do not qualify for the APM program and get a score above the low volume threshold in both segments of the eligibility determination period.

If you fulfill all these requirements, then go forward. You can be a MIPS reporting participant for MIPS reporting.

When you gain MIPS Eligibility as a Group Part

You can actively report in MIPS 2023 as a group participant if you belong to any finalized MIPS-eligible clinician type on Medicare Part B claims. You must appear as a Medicare provider before PY 2023.

A MIPS-eligible practice has to report to all clinicians as a group. Your group’s reporting will determine your MIPS final score. Then the payment adjustment will be done. The payment adjustment method will differ when you will receive a higher final score as an individual or APM Entity participant.

When you gain MIPS Eligibility as an APM Entity

By QPP’s policy, MIPS APM participants along with MIPS eligibility at the group or individual level, are allowed to report via traditional MIPS and Advanced APM Performance Pathway (APP).

When you gain MIPS Eligibility as a Virtual Group Participant

For getting eligibility as a Virtual group participant, you must take part in the Virtual Group election and associate your TIN with a Virtual Group. Your eligibility standard for the Virtual Group participation option is the same as described in the group level of participation.

  • Your clinician type must be one from the MIPS-eligible clinician list.
  • You get enrollment before 2023 as a Medicare provider.
  • You should not be a QP
  • Make sure you must practice in a practice that is a part of a virtual group and score above the low-volume threshold.

 When Voluntary Reporting is Suitable for You?

The only benefit of voluntarily reporting your data to MIPS is that you will be able to publish your data in the Doctors and Clinicians section of Care Compare. Anyhow, the consequence of voluntarily submitting your data as an individual or group is, you will not get a payment adjustment. This implies that you will be exempt from MIPS measure benchmark calculations as well. You will only get limited performance feedback. Mainly, the voluntary reporting option for MIPS acts as a preparatory phase for MIPS clinicians, thinking of participating in MIPS in the future. However, you can avail of this option of submitting your report voluntarily as an individual or a participant in the following situations:

  • When you are an opt-in eligible participant in MIPS and elect for such reporting.
  • When you are fully exempt from MIPS reporting.

I am an Advanced APM Entity participant. Am I still eligible for MIPS reporting?

If you belong to an identified clinician type on Medicare Part B claims then go for it. You can take part in MIPS reporting. But if by any chance you get QP status, you will face the MIPS exemption as a consequence. Thereby, QPP MIPS checks out your QP status in its three snapshots for final eligibility determination. The three MIPS snapshot dates in the eligibility determination period are March 31, June 30, and August 31 respectively. For MIPS-exempt clinicians to get partial QP status, they must appear in an election to retain their MIPS participation.

Conclusion

The eligibility determination period for MIPS 2023 reporting is a time for checking the eligibility for MIPS participation. As explained in the article, if MIPS-eligible clinicians secure their eligibility in the participation type they select, they will automatically get their payment adjustments in the future. Here, P3Care is your CMS-trusted MIPS-qualified registry for MIPS reporting in 2023. We not only offer MIPS consultancy but also report your data to CMS on your behalf. Enter in MIPS reporting 2023 performance year with our MIPS consultation services in USA for getting higher payment adjustments in the future.