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Small Practices

We’re committed to supporting small practices in their continued participation and success in the Quality Payment Program (QPP).

Small Practices Defined

In MIPS, a small practice is defined as 15 or fewer clinicians (identified by National Provider Identifier, or NPI) who’ve reassigned their billing rights to a single Taxpayer Identification Number (TIN). You can learn more about the small practice determination here on the Special Status page of the QPP website.

Support Available to Small Practices

Featured Resources

2024 MIPS Reporting Options for Small Practices

Provides an overview of the Merit-based Incentive Payment System (MIPS) reporting options for small practices in the 2024 performance year.

2024 Small Practice Action Planning Tool

This tool is for small practices interested in examining their 2022 final score to identify opportunities to improve performance in the 2024 performance year. This resource is accompanied by the Introduction to Small Practice Action Planning Tool video.

Additional Resources

FAQs

Check your current eligibility status. If you see a green check mark next to “Individual”, then you’re required to participate. Learn more about how your eligibility status can change.

Small practices without an EHR can still participate. Review the 2024 Reporting MIPS Quality Measures through Medicare Part B Claims Quick Start Guide for Small Practices to learn about submitting quality measures using Medicare Part B claims.

The Explore Measures & Activities tool lets you explore and find measures and improvement activities that are relevant to your practice. (Please ensure you select the appropriate performance year.)

Contact the QPP Service Center.

Performance Year

Select your performance year.

There are three reporting options available to MIPS eligible clinicians – traditional MIPS, MIPS Value Pathways (MVPs) and Alternative Payment Model (APM) Performance Pathway (APP).

Learn more about reporting options.

Policies for Small Practices

For the 2024 performance year, we remain committed to identifying flexibilities and options to help clinicians in small practices meaningfully participate and succeed in MIPS.  

These flexibilities apply to all 3 MIPS reporting options (traditional MIPS, MVPs, and the APP) unless otherwise specified.

Overall Flexibilities

 

  • Continuing to exclude individual  or groups with less than or equal to $90,000 in allowed charges for  under the Medicare Physician Fee Schedule (PFS) or less than or equal to 200 Medicare Part B patients who are furnished covered professional services under the Medicare PFS or less than or equal to 200 covered professional services under the Medicare PFS.
  • Continuing to give  and practices with 10 or fewer clinicians the choice to form a virtual group to participate with other practices. The election period for the 2024 performance year closed December 31, 2023.
  • Allowing clinicians in small practices to continue submitting quality measures for individual or group participation through Medicare Part B claims.

Quality Performance Category Requirements and Flexibilities

For the 2024 performance year, we'll award small practices 3 points for submitting:

  • Quality measures without an available benchmark (historical or performance period).  
  • Quality measures that don’t meet the case minimum or data completeness requirements.

Note: There are exceptions to these policies for measures calculated from administrative claims (these are generally excluded from scoring when the case minimum requirements aren’t met) and measures in their first or second performance period in the program (these have a 7- and 5-point scoring floor respectively, when data completeness requirements are met).

We’ll only calculate a group-level quality score from Medicare Part B claims measures if the practice submits group-level data in another performance category. This policy was effective beginning with the 2022 performance year.

We’ll continue to add 6 bonus points to the quality performance category score for clinicians in small practices who submit at least 1 measure, either individually or as a group or virtual group. This bonus isn’t added to clinicians or groups who are scored under facility-based scoring.  

Learn more about:

Promoting Interoperability Performance Category Requirements and Flexibilities

Small practices will receive automatic reweighting of the Promoting Interoperability performance category to 0%, regardless of whether they choose to participate as an individual, group, or virtual group. This policy was effective beginning with the 2022 performance year.

  • You don't need to submit a MIPS Promoting Interoperability Performance Category Hardship Exception application to request reweighting in this performance category.

You can still choose to submit Promoting Interoperability data, which would void reweighting of the performance category. We’ll score any data that's submitted.

Learn more about Promoting Interoperability reporting requirements (which are the same for all 3 reporting options).

Improvement Activities Performance Category Requirements and Flexibilities

Small practices, and those in rural locations and in health professional shortage areas, have reduced reporting requirements in traditional MIPS.

If you're in a small practice or located in a rural or health professional shortage area, you’ll receive full credit in this performance category when you perform and attest to:


  • or

Learn more about:

Performance Category Reweighting

We'll continue to use our performance category reweighting and redistribution policies for small practices. Under this methodology, we’ll increase the weight of the improvement activities performance category when other performance categories are reweighted to 0%.

When the Promoting Interoperability performance category is reweighted:

  • Quality will be weighted at 40%.
  • Cost will be weighted at 30%.
  • Improvement activities will be weighted at 30%.

When both the cost and Promoting Interoperability performance categories are reweighted:

  • Quality and improvement activities will be equally weighted at 50%.

Under our existing policies, when both the quality and Promoting Interoperability performance categories are reweighted:

  • Cost and improvement activities will be equally weighted at 50%.

Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)

If you bill for Medicare Part B services exclusively through the RHC or FQHC payment methods, then you aren't eligible for payment adjustments under MIPS. However, if you're a part of a RHC or FQHC and bill for Medicare Part B services under the PFS, then payment for those services could be eligible for MIPS payment adjustments.

If you practice in a CAH, you may be eligible to participate in MIPS, but there are some differences in how the payment adjustment is applied.

Review the 2024 MIPS Payment Year Payment Adjustment User Guide for more information about how MIPS payment adjustments are applied.