The Quality Payment Program (QPP) automatically assigns special statuses to MIPS eligible clinicians, practices, virtual groups, and APM Entities who meet certain criteria. If you're assigned a special status, your reporting requirements may be affected.
Performance Year
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2021 Special Statuses
How do I Know if I Have a Special Status?
Individuals and Groups
If you've been assigned a special status at the clinician or practice level, it will be added to your eligibility profile in the QPP Participation Status Tool.
Virtual Groups and APM Entities
- If you’ve been assigned a special status, you will need to sign in to qpp.cms.gov to view any special statuses
- Small practice is the only special status available to APM Entities.
If you've been assigned a special status in Segment 2 of the MIPS determination period, it may not appear in the QPP Participation Status Tool until late 2021.
If you think you should have a special status or believe there is a mistake in your special status designation, contact the Quality Payment Program.
How is Special Status Determined?
To determine if a MIPS eligible clinician, practice, virtual group or APM Entity will be assigned a special status, we retrieve and analyze Medicare Part B claims data.
Special statuses are assigned if you reach the requirements for at least one of the MIPS determination segments.
Learn more about MIPS determination segments.
Special Status Impacts and Circumstances
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Ambulatory Surgery Center (ASC)-based
If you are ASC-based, you qualify for automatic reweighting of the Promoting Interoperability performance category to 0%. The 25% category weight will be redistributed to another performance category (or categories) unless you choose to submit Promoting Interoperability data.
Level | You will Receive this Special Status if... |
---|---|
Clinician | The MIPS eligible clinician furnishes 75% or more of their covered professional services in sites of service identified by Place of Service (POS) code 24. |
Practice | All MIPS eligible clinicians associated with the practice are designated as ASC-based. |
Virtual Group | All MIPS eligible clinicians associated with the virtual group are designated as ASC-based. |
Hospital-based
If you are hospital-based, you qualify for automatic reweighting of the Promoting Interoperability performance category to 0%. The 25% category weight will be redistributed to another performance category (or categories) unless you choose to submit Promoting Interoperability data.
Level | You will Receive this Special Status if... |
---|---|
Clinician | The MIPS eligible clinician furnishes 75% or more of their covered professional services in a hospital setting. How is a service determined to be hospital-based? |
Practice | More than 75% of the clinicians billing under the practice’s TIN meet the definition of hospital-based. |
Virtual Group | More than 75% of the clinicians billing within the virtual group meet the definition of hospital-based. |
Non-patient Facing
If you are non-patient facing, you will earn 2x the points for each improvement activity you submit.
You will also qualify for automatic reweighting of the Promoting Interoperability performance category to 0%. The 25% category weight will be redistributed to another performance category or categories unless you choose to submit Promoting Interoperability data.
Level | You will Receive this Special Status if... |
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Individual | The MIPS eligible clinician has 100 or fewer Medicare Part B patient-facing encounters (including telehealth services). |
Practice | More than 75% of the clinicians billing under the practice’s TIN meet the definition of non-patient facing. |
Virtual Group | More than 75% of the clinicians billing within a virtual group meet the definition of a non-patient facing. |
Small Practice
You will earn 2x the points for each improvement activity you submit. If you submit at least one quality measure, you will also receive 6 bonus points in the Quality performance category.
Level | You will Receive this Special Status if... |
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Clinician | The MIPS eligible clinician is one of 15 or fewer clinicians billing under the practice's TIN. |
Practice | 15 or fewer clinicians bill under the practice’s TIN. |
Virtual Group | 15 or fewer clinicians bill under TINs that participate in a virtual group. |
APM Entity | 15 or fewer clinicians associated with the APM Entity. |
Health Professional Shortage Area (HPSA)
You will earn 2x the points for each improvement activity you submit.
Level | You will Receive this Special Status if... |
---|---|
Clinician | The MIPS eligible clinician practices in an area designated as an HPSA. |
Practice | More than 75% of the clinicians billing under the group’s TIN are in an area designated as an HPSA. |
Virtual Group | More than 75% of the clinicians billing in the virtual group are in an area designated as an HPSA. |
Rural
You will earn 2x the points for each improvement activity you submit.
Level | You will Receive this Special Status if... |
---|---|
Clinician | The MIPS eligible clinician is associated with a practice in a ZIP code designated as rural by the Federal Office of Rural Health Policy (FORHP) using the most recent FORHP Eligible ZIP code file available. |
Practice | More than 75% of the clinicians billing under the practice’s TIN are in a ZIP code designated as rural using the most recent FORHP ZIP code file. |
Virtual Group | More than 75% of the clinicians billing in the virtual group are in a ZIP code designated as rural using the most recent FORHP ZIP code file. |