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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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.
Level | Applies To | You'll Receive This Special Status If... |
---|---|---|
Clinician | Individual participation | 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 (ambulatory service center). |
Practice | Group and subgroup participation | All MIPS eligible clinicians billing under the practice’s TIN meet the definition of ASC-based. |
Virtual Group | Virtual group participation | All 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.
Level | Applies To | You'll Receive This Special Status If... |
---|---|---|
Clinician | Individual participation | The 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. |
Practice | Group and subgroup participation | More than 75% of the clinicians billing under the practice’s TIN meet the definition of hospital-based. |
Virtual Group | Virtual group participation | More 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.
Level | Applies To | You'll Receive This Special Status If... |
---|---|---|
Clinician | Individual participation | The 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. |
Practice | Group and subgroup participation | 75% or more of the clinicians billing under the practice’s TIN meet the definition of facility-based. |
Virtual Group | Virtual group participation | 75% 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.
Level | Applies To | You'll Receive This Special Status If... |
---|---|---|
Clinician | Individual participation | The MIPS eligible clinician has 100 or fewer Medicare Part B patient-facing encounters (including telehealth services). |
Practice | Group and subgroup participation | More than 75% of the clinicians billing under the practice’s TIN meet the definition of non-patient facing. |
Virtual Group | Virtual group participation | More 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.
Level | Applies To | You'll Receive This Special Status If... |
---|---|---|
Clinician | Individual participation | The MIPS eligible clinician is one of 15 or fewer clinicians billing under the practice's TIN. |
Practice | Group and subgroup participation | 15 or fewer clinicians bill under the practice’s TIN. |
Virtual Group | Virtual group participation | 15 or fewer clinicians bill under TINs that participate in a virtual group. |
APM Entity | APM Entity participation | 15 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.
Level | Applies To | You'll Receive This Special Status If... |
---|---|---|
Clinician | Individual participation | The MIPS eligible clinician practices in an area designated as an HPSA. |
Practice | Group and subgroup participation | More than 75% of the clinicians billing under the group’s TIN are in an area designated as an HPSA. |
Virtual Group | Virtual group participation | More 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.
Level | Applies To | You'll Receive This Special Status If... |
---|---|---|
Clinician | Individual participation | 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 | Group and subgroup participation | 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 | Virtual group participation | 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. |