>> Molly MacHarris: Who participates in the
merit-based incentive payment system?
I'm Molly MacHarris with CCSQ, and I will be leading
you through this discussion.
So, who is eligible to participate under the
MIPS program?
Those clinicians that are eligible include physicians,
physician assistants, nurse practitioners, clinical
nurse specialists, and certified registered
nurse anesthetists.
Please note that, when we talk about physicians here
at Medicare, we mean not only M.D.s and D.O.s, but we
also mean dentists pediatrists, and optometrists.
Additionally, we have certain levels of exclusions
under the MIPS program.
The first exclusion that everyone should be aware of
is that if a clinician bills more than 30,000 annually
and provides care for more than 100 patients, they are
eligible to participate in the MIPS program.
There are some additional exclusions that we have
available under the MIPS program, which include
clinicians who are newly enrolled in Medicare.
So, if the very first time you become enrolled in
Medicare -- if that's during 2017, which is the initial
performance period -- you are not eligible to
participate in MIPS.
You would, however, be eligible to participate in a
future here.
The third exclusion on the slide, on the right-hand
side, deals with significant participation and advanced APMs.
We have more information on how to meet this exclusion
under other training modules which will be offered, so I
would encourage folks to take a look at the training
modules that deal with participation through APMs.
And then the middle exclusion I touched on just
a little bit earlier, which is the low-volume threshold.
I do want to note something here, which deals with the
30,000 or 100 patients.
And you'll recall from the previous slide, it listed
30,000 and 100 patients.
And I think, if we advance to the next slide, there is
an example for this.
So, the example is: "I would like to know whether I'm
exempt from the MIPS if I exceed either the physician
fee schedule charges or the beneficiary count, but
not both."
So, we wanted to be really clear to everyone on exactly
how this will work, because I can understand why it can
be confusing where, in some instances, we say that these
two elements either/or have to be met, but then in some
instances they both have to be met.
And it gets into a bit of a double negative, so I
apologize in advance.
But the way that it works is that, when you're talking
about who is eligible to participate -- meaning, from
the positive end -- it's an "and," meaning clinicians
would need to have 30,000 in billing and see more than
100 patients.
When you talk about it from the negative end, however --
meaning, from who is excluded -- it's an "or."
So, clinicians are excluded if they see less than or
equal to 30,000 or less than or equal to 100 patients.
We have an example on this slide here, that provides a
scenario where a clinician would be exempt.
So, their billing is 29,000 and they see 101 patients.
So, then, they would be exempt.
There are a couple additional eligibility
scenarios that all eligible clinicians should be aware of.
An additional eligibility scenario deals with those
clinicians who are considered to be
non-patient-facing.
Non-patient-facing clinicians are typically
pathologists and certain types of radiologists.
There also are a few other specialties as well.
Non-patient-facing clinicians are eligible to
participate under the MIPS program.
In some instances, however, they have different scoring
rules that would be applied under some of the
performance categories.
Thank you for viewing this presentation.
For more information, please visit the Quality Payment
Program website at qpp.cms.gov.