MIPS is the first large scale value-based payment model to impact PTs.
The three 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.
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.
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%.
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.
Additional Merit-Based Incentive Payment System Content
Jan 19, 2021 / News
The APTA Physical Therapy Outcomes Registry has been approved as a qualified clinical data registry — an important benefit for PTs in MIPS.
Dec 22, 2020 / Resource
APTA provides details for the different MIPS data collection reporting mechanisms.
Dec 8, 2020 / Review
Like the proposed version, the final rule from CMS keeps the Quality Payment Program mostly as-is.
Apr 23, 2020 / Article
Aug 7, 2020 / Review
The Quality Payment Program would see mostly minor changes and some shifts to respond to COVID-19-related challenges.
Aug 7, 2020 / News
CMS has released its MIPS scores for your 2019 performance, which could affect your payment in 2021.
Jun 29, 2020 / News
The "Extreme and Uncontrollable Circumstances" exception could allow clinicians to have MIPS performance categories reweighted.
Jun 13, 2020 / Resource
Access data collections sheets for claims-based MIPS reporting for 2020.
Apr 1, 2019 / Column
This is what you need to know now.
Dec 5, 2018 / Article
This course provides insights into the New Year based on moving to value-based payment. Recorded webinar. Free to members.