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How do we determine MIPS eligibility?


Clinicians who need to submit data to MIPS
If you're included in MIPS in 2017, you will need to decide whether to report as an individual or with a group. For 2017 (Performance Year 1), these clinicians will be included in MIPS:
  • Physicians (including doctors of medicine, doctors of osteopathy, osteopathic practitioners, doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors)
  • Physician's assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Groups that includes such clinicians
  • Clinicians who have billed more than $30,000 in Medicare Part B allowable charges and have more than 100 Part B-enrolled Medicare beneficiaries

Clinicians who aren't included in MIPS
If you're exempt from MIPS in 2017, you won't need to do anything else for MIPS this year. For 2017 (Performance Year 1), these clinicians will be exempt from MIPS:
  • Clinicians who enroll in Medicare for the first time in 2017
  • Clinicians who participate in an Advanced APM and are either a Qualifying APM Participant (QP) or Partial QP
  • Clinicians who bill Medicare for $30,000 or less
  • Clinicians who have provided care for 100 Medicare patients or fewer
  • Clinicians who are not in a MIPS-eligible specialty

Clinicians participating in Advanced APMs

If you have a certain percentage of your Part B payments through an Advanced APM or see a certain percentage of your patients through an Advanced APM, you will not have to submit data to MIPS.

During the QPP performance period, CMS will take three "snapshots" (on March 31, June 30, and August 31) to see which clinicians are participating in an Advanced APM and whether they meet the thresholds to become Qualifying APM Participants (QPs).

If you participate in Advanced APMs, but don't meet the threshold, you may become a Partial QP. Partial QPs can choose if they want to participate in MIPS.


Review Periods

For 2017 (Performance Year 1), your eligibility will be reviewed at two different times in the year. If you are determined exempt during the first review, you won't have to submit any MIPS data for that reporting year.

CMS completed the first review in December 2016 by examining claims from September 1, 2015 through August 31, 2016. We reviewed Medicare Part B Claims data and PECOS data and will only apply it to 2017 (Performance Year 1).

CMS will complete the second review in December 2017. We will examine Medicare Part B Claims data from September 1, 2016 through August 31, 2017 and PECOS data.


Check if you are clinician who bills to Medicare and needs to submit data to MIPS by simply entering your National Provider Identifier (NPI) number into our tool.

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