decisionhealth Newsletters, Part B News - 2016 Issue 10 (October)
Low volume biggest reason for practices to qualify for MIPS exclusion
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Article Overview
This article summarizes CMS’s early Quality Payment Program guidance on MIPS exclusions for certain clinicians and practices, including low-volume status, first-time Medicare billing, and qualifying APM participation. It is intended for practices, clinicians, and coding/billing professionals tracking Medicare reporting requirements and program eligibility under the 2017 framework. The discussion is high-level and focuses on the general categories of exclusion described in the final rule.
Why This Topic Matters
Understanding whether a practice or clinician is subject to MIPS affects Medicare reporting obligations and participation in the Quality Payment Program. The article helps readers identify the broad eligibility categories CMS used when estimating who would be excluded from MIPS.
What You Will Learn
- The main CMS categories that may exclude clinicians from MIPS participation
- How low-volume status is described in the Quality Payment Program context
- Which kinds of clinicians are considered newly enrolled for reporting purposes
- What it means to be a qualifying APM participant in broad program terms
- How CMS framed the estimated scope of MIPS exclusions for 2017
Who Should Read This
- Physicians and clinicians
- Medical practice managers
- Billing and coding professionals
- Revenue cycle staff
- Healthcare compliance teams
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