Medical Billing Blog

CMS to Release MIPS Exemption Notifications Soon

Posted by Scott Shatzman on Mon, Apr, 10, 2017 @ 13:04 PM

Under the Merit-based Incentive Payment System (MIPS) eligible clinicians (EC) are to report quality and cost data to CMS starting this year (2017). This data will be used to determine Medicare Quality Payment Program (QPP) adjustments (positive or negative) in 2019. Because 2017 has been designated as a “transition” year, the amount of reporting required of ECs is minimal.

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However, readers may recall that MIPS also includes an exemption from MIPS reporting and payment adjustments if the EC is designated as a “low volume” provider – those ECs with less than $30,000 in allowable Medicare charges or that saw fewer than 100 Medicare beneficiaries during either of the benchmark year(s) associated with the reporting year. For purposes of the 2017 reporting year, the benchmark years are either 2015 or 2016. By law, CMS is to notify ECs if they qualify as a low-volume provider prior to the start of the reporting year.

Clearly, CMS failed to meet that requirement for 2017.

Even though we are well into the first reporting year for the new Medicare Quality Payment Program (QPP), CMS has yet to notify any ECs of their “exempt” status for 2017.

CMS estimates that thousands of ECs will be exempt from MIPS reporting in 2017 because they fall below the low volume threshold. The low-volume exception will be made each year and ECs qualifying should be announced by December preceding the reporting year.

ECs must fall below the low-volume threshold each reporting year to qualify for the exemption. ECs who qualify for the low-volume exception are subsequently exempt from the MIPS payment adjustments for the corresponding payment year.

MIPS also includes several caveats for the reporting requirements for certain provider-types and specialties. For example, hospital-based ECs are exempt from reporting under the Advancing Care Information (ACI) category. This category measures an EC’s use of technology including electronic health records (EHR). This exemption recognizes that hospital-based ECs do not have control over the EHR provided to them by their facility. Additionally, non-patient-facing ECs have reduced reporting requirements for some categories.

The Centers for Medicare and Medicaid Services (CMS) was supposed to notify ECs if they qualify for these exemptions in December but those notifications have yet to be sent out. Over the past few weeks, several industry stakeholder groups have been pressuring CMS to send the overdue exemption letters to ECs to provide them with certainty that they do not have to report under MIPS in 2017. CMS has acknowledged the fact that the letters were not sent out on time but that they will be sent out this spring.

CMS decided to make 2017 a “transition” year. For the transition year, CMS has created several participation tracks to help ECs transition into the new QPP while also making it easier to avoid the negative payment adjustments. For the transition year, ECs can essentially report any amount of data to avoid negative payment adjustments but can become eligible for positive payment adjustments if they choose to fully report MIPS data for either 90 days or the full year. ECs who fail to report data will receive the full four percent negative payment adjustment in 2019.