MIPS is the first large scale value-based payment model that will impact PTs—beginning January 1, 2019, some PTs in private practice are required to participate; others are able to do so by choice. The 3 types of participation are described below. For PTs who are eligible but not required to participate, participation will be a business decision in which they must weigh the benefits of earning incentives with the risk for penalties. APTA has created resources to help PTs navigate this program. 

Navigate MIPS options

Mandatory Participation

PTs in private practice who exceed all 3 criteria of the low-volume threshold (annually receive more than $90,000 in Medicare part B payments AND provide care for more than 200 Part B-enrolled Medicare beneficiaries AND bill more than 200 professional services), must participate in MIPS, subject to the payment adjustment of +/-9%. Nonparticipation will result in the full 9% penalty.

Opt-in Participation

Individual PTs: PTs in private practice who exceed 1 or 2 of the low-volume threshold criteria (annually receive more than $90,000 in Medicare part B payments OR provide care for more than 200 Part B-enrolled Medicare beneficiaries OR bill more than 200 professional services), will be eligible to opt in to MIPS, subject to the payment adjustment of +/-9%. 

Groups: If a practice collectively exceeds 1, 2, or all 3 of the low-volume threshold criteria it can opt-in to MIPS as a group, subject to the payment adjustment of +/-9%.

Voluntary Participation

PTs who don't meet the low-volume threshold and choose not to opt in to participation will be able to report MIPS data voluntarily without being subject to the payment adjustment.