2018 MIPS Eligibility Assessment

By Marina Verdara  |  December 15, 2017

In 2018, all eligible providers will need to begin participation in MACRA’s Quality Payment Program (QPP) to avoid potentially significant penalties. It will be important to find out how this could impact Medicare Part B reimbursements for your practice.

First, use this eligibility assessment to learn if you need to participate in the QPP. And if so, what track you will be in — the Merit Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

2018 MIP Eligibility Assessment

Who Participates?

The following eligible clinicians (EC) must participate in the QPP in either MIPS or Advanced APMs:

  • Physician (Doctors of Medicine or Osteopathy, Doctors of Dental Surgery or Dental Medicine, Doctors of Podiatric Medicine, Doctors of Optometry, Chiropractors)
  • Physician Assistant
  • Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registered Nurse Anesthetist

However, the following providers are excluded from the QPP in 2018:

  • Providers in their first year of Medicare in 2018.
  • Providers who see 200 or fewer Medicare patients each year.
  • Providers with $90,000 or less in annual Medicare Part B claims.

Frequently Asked Questions

Do You Need a Certified EHR to participate in the QPP? Yes, for both MIPS and the Advanced APMs, you need a certified EHR. For 2018, the EHR must be 2014 Edition or 2015 Edition certified. Providers using a 2015 Edition receive a 10% bonus to their Advancing Care Improvement score.

I am in an APM that is not on the list of Advanced APMS. Do I participate in MIPS then? Yes, you do participate in MIPS to avoid a negative payment adjustment. However, you may be in a different scoring system depending on your model. For more information on the scoring for APMs under MIPS and how it may impact you, visit: https://qpp.cms.gov/mips/what-to-report.

What help is available for small practices to participate in the QPP? The CMS has allotted $20 million a year to provide technical assistance to practices with 15 or fewer eligible clinicians participating in MIPS. Click here to find help in your area.

Where can I find more information about the Quality Payment Program? Visit kareo.com/macra or call 888-775-2736 to talk to a Kareo MACRA Solutions Consultant. Or go directly to the CMS Quality Payment Program website for more information. 

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