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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

Select your performance year.

2024 Special Statuses

  • We retrieve and analyze Medicare Part B claims data to determine whether you qualify for a special status. 
  • Most special statuses are assigned if you meet the criteria in 1 of the 2 segments of the MIPS Determination Period.
  • If you qualify for a special status in Segment 2 of the MIPS Determination Period, it won't appear until December 2024.

How Do I Know If I Have a Special Status?

Individuals, Groups, and Subgroups

  • Review your eligibility profile in the QPP Participation Status Tool and on the Eligibility & Reporting page when you sign in to the Quality Payment Program website.
  • Clinician-level special statuses apply to individual participation.
  • Practice-level special statuses apply to both group and subgroup participation.

Note: The subgroup participation option is only available for the MIPS Value Pathways (MVPs) reporting option and requires advance registration.

Virtual Groups and APM Entities

 

  • Sign in to the Quality Payment Program website to view any special statuses on the Eligibility & Reporting page.

Note: Small practice designation is the only special status available to APM Entities.

Special Statuses: Impacts and Circumstances

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Ambulatory Surgery Center (ASC)-based

You qualify for automatic reweighting of the Promoting Interoperability performance category to 0%. 

  • The performance category weight will be redistributed to another performance category (or categories) unless you choose to submit Promoting Interoperability data.
  • This automatic reweighting applies to all 3 MIPS reporting options.
LevelApplies ToYou'll Receive This Special Status If...
ClinicianIndividual participationThe MIPS eligible clinician furnishes 75% or more of their covered professional services in sites of service identified by Place of Service (POS) code 24 (ambulatory service center).
PracticeGroup and subgroup participationAll MIPS eligible clinicians billing under the practice’s TIN meet the definition of ASC-based.
Virtual GroupVirtual group participationAll MIPS eligible clinicians billing within the virtual group meet the definition of ASC-based.

Hospital-based

You qualify for automatic reweighting of the Promoting Interoperability performance category to 0%. 

  • The performance category weight will be redistributed to another performance category (or categories) unless you choose to submit Promoting Interoperability data.
  • This automatic reweighting applies to all 3 MIPS reporting options.
LevelApplies ToYou'll Receive This Special Status If...
ClinicianIndividual participationThe MIPS eligible clinician furnishes 75% or more of their covered professional services in a hospital setting as identified by Place of Service (POS) Codes 19, 21, 22, and 23. Learn more.
PracticeGroup and subgroup participationMore than 75% of the clinicians billing under the practice’s TIN meet the definition of hospital-based.
Virtual GroupVirtual group participationMore than 75% of the clinicians billing within the virtual group meet the definition of hospital-based.

Facility-based

You may qualify for facility-based scoring.

  • Your assigned facility’s Hospital Value-Based Purchasing (VBP) Program score can be used for scoring the MIPS quality and cost performance categories in traditional MIPS without submitting additional quality measures.
  • Groups and virtual groups need to submit improvement activities or Promoting Interoperability data to receive facility-based scoring.

Unlike other special statuses:

  • This status is predictive. We won’t know until the end of the performance year if your assigned facility has the Hospital VBP Program score needed for facility-based scoring.
  • If your assigned facility doesn’t have a Hospital VBP Program score, you’ll need to report MIPS quality measures. 
  • This status is based solely on claims from segment 1 of the . You can't gain this status when we update eligibility after segment 2 of the MIPS Determination Period.
LevelApplies ToYou'll Receive This Special Status If...
ClinicianIndividual participationThe MIPS eligible clinician furnishes 75% or more of their covered professional services in a hospital setting (Place of Service (POS) codes 21, 22 or 23). Learn more.
AND 
Bills at least one service in an inpatient hospital or emergency room. 
AND 
Are assigned to a facility that participates in the Hospital VBP Program.
PracticeGroup and subgroup participation75% or more of the clinicians billing under the practice’s TIN meet the definition of facility-based.
Virtual GroupVirtual group participation75% or more of the clinicians billing within the virtual group meet the definition of facility-based.

Non-patient Facing

You'll earn 2x the points for each improvement activity you submit when reporting traditional MIPS.

You also qualify for automatic reweighting of the Promoting Interoperability performance category to 0%.
 

  • This automatic reweighting applies to all 3 MIPS reporting options.
  • The performance category weight will be redistributed to another performance category (or categories) unless you choose to submit Promoting Interoperability data.
LevelApplies ToYou'll Receive This Special Status If...
ClinicianIndividual participationThe MIPS eligible clinician has 100 or fewer Medicare Part B patient-facing encounters (including telehealth services).
PracticeGroup and subgroup participationMore than 75% of the clinicians billing under the practice’s TIN meet the definition of non-patient facing.
Virtual GroupVirtual group participationMore than 75% of the clinicians billing within a virtual group meet the definition of non-patient facing.

Small Practice

There are a number of special scoring scenarios that apply to small practices:

  • You'll earn 2x the points for each improvement activity you submit when reporting traditional MIPS.
  • You’ll receive 6 bonus points in the quality performance category if you submit at least one quality measure. These bonus points are available in all 3 MIPS reporting options.
  • You’ll continue to receive 3 points (instead of zero) for quality measures that don’t meet data completeness or case minimum requirements, or that can’t be reliably scored against a benchmark. This applies to all 3 MIPS reporting options.
  • You qualify for automatic reweighting of the Promoting Interoperability performance category to 0%. This automatic reweighting applies to all 3 MIPS reporting options. The performance category weight will be redistributed to other performance categories unless you choose to submit Promoting Interoperability data.
  • You also qualify for a different redistribution policy when the Promoting Interoperability performance category is reweighted.
LevelApplies ToYou'll Receive This Special Status If...
ClinicianIndividual participationThe MIPS eligible clinician is one of 15 or fewer clinicians billing under the practice's TIN.
PracticeGroup and subgroup participation15 or fewer clinicians bill under the practice’s TIN.
Virtual GroupVirtual group participation15 or fewer clinicians bill under TINs that participate in a virtual group.
APM EntityAPM Entity participation15 or fewer clinicians associated with the APM Entity.

Health Professional Shortage Area (HPSA)

You'll earn 2x the points for each improvement activity you submit when reporting traditional MIPS.

LevelApplies ToYou'll Receive This Special Status If...
ClinicianIndividual participationThe MIPS eligible clinician practices in an area designated as an HPSA.
PracticeGroup and subgroup participationMore than 75% of the clinicians billing under the group’s TIN are in an area designated as an HPSA.
Virtual GroupVirtual group participationMore than 75% of the clinicians billing in the virtual group are in an area designated as an HPSA.

Rural

You'll earn 2x the points for each improvement activity you submit when reporting traditional MIPS.

LevelApplies ToYou'll Receive This Special Status If...
ClinicianIndividual participationThe 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.
PracticeGroup and subgroup participationMore 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 GroupVirtual group participationMore 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.

Additional Resources