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Think you know where you stand when it comes to participation in Medicare's Merit-based Incentive Payment System, or MIPS? Are you sure things haven't changed? There's a way to find out.

The U.S. Centers for Medicare & Medicaid Services has updated its online tool that shows providers whether they're required to participate in MIPS in 2022, and although you think you may know the answer, it's worth checking. The reason? CMS has factored in new data, which means your status may have changed.

The specific data that may have changed your status is related to the second segment of the MIPS eligibility determination period, which ran from October 2021 through September of this year. According to CMS, the status determination now available is final unless you participate in an Advanced Alternative Payment Model, and your status is adjusted due to data related to the most recent APM snapshot for the 2022 performance year.

The online tool also helps you find out if you're excluded from MIPS based on the program's low-volume threshold, which is applied if a provider meets any of the following:

  • You billed $90,000 or less in Medicare Part B charges during either of the previous two MIPS eligibility determination periods, which ran from October 2020 through September 2021, and from October 2021 through September 2022.
  • You provided care to 200 or fewer Part B beneficiaries during either of the two determination periods.
  • You provided 200 or fewer covered professional services during either of the two determination periods.

CMS revisits the participation status tool regularly and expects to offer updates again in July, October, and December 2023. The December 2023 update will include final eligibility determinations for 2023 MIPS performance.

[For the basics on MIPS, visit APTA's webpage on the program.]

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