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The first step for anyone with questions regarding MIPS is to check your eligibility, also known as, reporting requirements.
- Step 1: Lookup Eligibility
- Step 2: Interpreting Eligibility
- Once practices find the “Associated Practice” that is using Elation, there are three possible outcomes, only one of which requires practices to participate in MIPS (see below).
Eligibility Note: if you or your practice are associated with and participating in an APM (ACO or other APM type) contact the APM administrator to determine best practices for MIPS participation and data submission. MIPS APM participation may vary from traditional MIPS participation. MIPS data and quality data are generally submitted via the APM and that is important to understand.
This is a logic determination visual shared by CMS:
All of this information is based on regulatory statue with this eligibility determination.
The following Clinician Types are eligible for MIPS:
- Physicians (MD, DO, DDS, DMD, DPM, OD)
- Osteopathic practitioners
- Chiropractors
- Physician assistants
- Nurse practitioners
- Clinical Nurse Specialists
- Certified nurse anesthetists
- Physical therapists
- Occupational therapists
- Clinical psychologists
- Qualified speech-language pathologists
- Qualified audiologists
- Registered dietitians or nutrition professionals
- Clinical social workers
- Certified nurse-midwives
- Clinical nurse specialists
If any of the following apply to the provider, they are not required to participate in MIPS:
- Fewer than 200 Medicare fee-for-service patients
- Less than $90,000 in Medicare charges
- Fewer than 200 Medicare fee schedule services
- Participate in an Advanced APM
- First-year Medicare provider
For questions regarding eligibility specifically, please contact the QPP helpdesk for further support. The QPP helpdesk is the support center for all things related to MIPS and provides the best support.
QPP helpdesk
- Hours: Monday - Friday 8 a.m - 8 p.m Eastern Time
- Phone: 1-866-288-8292 (TRS: 711)
- Email: QPP@cms.hhs.gov
