decisionhealth Newsletters, Part B News - 2018 Issue 2 (February)
CMS holds MIPS eligibility information; check your billings to get a clue
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Article Overview
This article covers CMS timing around MIPS eligibility notifications, the windows used to determine participation status, and practical considerations for practices trying to decide whether they may be affected. It is aimed at clinicians, small practices, and billing or quality-reporting staff who need to understand the general framework for determining MIPS eligibility and why checking historical billings matters. The piece also discusses broader reporting context, including performance periods, data completeness, and the increasing importance of preparing for future years.
Why This Topic Matters
MIPS eligibility affects whether clinicians must participate in federal quality reporting and whether they face penalties or other program impacts. The article helps readers understand why delays in CMS tools and notices can create risk for practices that are close to the eligibility thresholds.
Article Sections
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Eligibility timing and reporting context
An overview of the timing gap between CMS eligibility information and the start of the reporting period, along with the general reporting context for MIPS categories and completeness requirements.
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How eligibility is determined
A discussion of the CMS time windows used to assess eligibility, the role of the online eligibility tool, and related notices sent to clinicians.
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Before assuming, ask 3 questions
General factors practices can consider when estimating whether they may be included in the program, including payer mix, historical billings, and timing concerns.
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Better not wait
Why experts advise gaining familiarity with the program even if a practice expects to be excluded, and how future performance expectations are framed.
What You Will Learn
- How CMS timing can affect MIPS eligibility awareness
- What broad periods CMS uses to evaluate eligibility
- Why historical billing review can help estimate possible program impact
- What general practice considerations matter when deciding whether to prepare for reporting
- Why early familiarity with MIPS may matter for future performance periods
Who Should Read This
- Clinicians
- Small medical practices
- Billing staff
- Quality reporting staff
- Practice managers
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