CMS News – Eligibility Status for Quality Payment Program

Please be on alert to receive a letter from the Centers for Medicare & Medicaid Services (CMS) regarding Quality Payment Program participation for 2017. Health Quality Innovators (HQI) learned that CMS sent out letters to all clinicians regarding eligibility status in Quality Payment Program for 2017 last week. All taxpayer identification number (TIN) entities enrolled in Medicare received a letter with two attachments. The letter lets you know if your group and the individuals in your group are exempt from Merit-based Incentive Payment System (MIPS) because of any of the reasons below:

  • Being a low-volume clinician (being below established program thresholds)
  • Being a new Medicare enrolled clinician (in their first year of Part-B participation)
  • Being in a category of clinicians that is not eligible for the first two years of Quality Payment Program
  • Being a Qualified Participant in an Advanced Alternative Payment Model
All TINs will receive a letter and clinicians who practice under multiple TINs will be notified at the TIN level of their eligibility and may have different eligibilities for each of their TIN/practice combinations. There will also be a Quality Payment Program FAQ attachment with the letters. As a reminder, clinicians who do not meet one of these categories and are required to participate in MIPS for 2017 will face a negative payment adjustment of 4%.

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