MIPS exclusions expected to relieve 57% of providers from quality-reporting duties

Why This Topic Matters

Understanding who is excluded from MIPS affects whether a practice must prepare for reporting, potential payment adjustments, and CMS eligibility checks. The article helps readers assess whether their organization may be exempt under first-year participation criteria and what CMS review methods may apply.

Article Sections

1. Quality Payment Program overview

   Introduces CMS’s new Medicare quality-reporting program and the context for first-year participation.

2. MIPS exclusion categories

   Summarizes the main groups of clinicians who may be excluded from MIPS in the program’s first reporting year.

3. Low-volume threshold changes

   Describes the revised low-volume framework and how it affects eligibility determinations for providers and groups.

4. Newly Medicare-enrolled clinicians

   Explains how recently enrolled Medicare providers are treated during the reporting period and the following year.

5. Alternative payment model participation

   Covers the relationship between qualifying alternative payment model status and MIPS eligibility.

6. CMS low-volume review process

   Outlines CMS claims-based review timing and the planned lookup feature for checking exclusion status.