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Quality Payment Program (QPP) Support Center

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Are you eligible for free Assistance?

Our services are free to practices with 15 or fewer MIPS Eligible Clinicians in Delaware, New Jersey, Pennsylvania and West Virginia. Check the list below for your MIPS eligibility and visit CMS' QPP Website for more information.
 

image of provider groupMIPS Eligible Clinicians in 2018

  • 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 assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Groups or virtual groups that include one or more of the clinician types above
If you are included in MIPS for Performance Year 2018, you will need to decide whether to report as an individual or group. Read more about this choice.
 

Low-Volume Threshold

You’re excluded if you or your group has ≤$90,000 in Part B allowed charges or ≤200 Part B beneficiaries.
 

Review Dates

For Performance Year 2018, the first review was completed in December 2017 by examining claims from September 1, 2016 through August 31, 2017. The Centers for Medicare & Medicaid Services (CMS) reviewed Medicare Part B Claims data and PECOS data and will only apply it to PY 2018.

CMS will complete the second review in late 2018. It will examine Medicare Part B Claims data from September 1, 2017 through August 31, 2018 and PECOS data. If you joined a new practice during this time period, your eligibility under that practice will be evaluated during the second review.
 
Non-patient facing: Individual
A clinician is considered non-patient facing if he/she has 100 or fewer Medicare Part B patient-facing encounters (including Medicare telehealth services) during the non-patient-facing determination period, during one of the segments of the 24-month non-patient-facing determination period (September 1, 2016 - August 31, 2017 or September 1, 2017 - August 31, 2018).
 
Non-patient facing: Group
A group is considered non-patient facing if more than 75% of the clinicians (NPIs) billing under the group’s TIN meet the definition of a non-patient-facing individual MIPS eligible clinician during one of the segments of the 24-month non-patient facing determination period (September 1, 2016 - August 31, 2017 or September 1, 2017 - August 31, 2018).
 

Certified Electronic Health Record Technology (CEHRT) Hardship Exception

For Performance Year 2018, CEHRT is required for participation in the Promoting Interoperability (formerly Advancing Care Information) performance category of the Quality Payment Program (QPP).

Under MIPS scoring, MIPS eligible clinicians and groups may qualify for a re-weighting of their Promoting Interoperability (formerly Advancing Care Information) performance category score to 0 percent of the final score if they meet the criteria outlined. Simply lacking CEHRT does not qualify the MIPS eligible clinician or group for reweighting. Learn more about Exception Applications.