MGMA: CMS late again on notifying clinicians of MIPS eligibility

Full-year quality reporting will be required in the Merit-based Incentive Payment System (MIPS) for the first time in 2018, but clinicians haven’t received word from CMS on whether they’re eligible to participate, according to the Medical Group Management Association (MGMA).

The MGMA made a similar complaint on overdue eligibility notifications last year. It took until May for CMS to announced that more than 800,000 clinicians—65 percent of Medicare providers—were told they were exempt from MIPS. In a Jan. 10 letter, MGMA’s senior vice president of government affairs, Anders Gilberg, said physicians need those notices immediately so practices can meet the expanded quality reporting requirements.

“We are extremely concerned that despite being held accountable for reporting that began more than a week ago, physicians do not have basic eligibility information to determine whether they are even included in the MIPS program,” Gilberg wrote. “For medical group practices that manage reporting for dozens or even hundreds of clinicians under the program, this information is vital to the complex clinical and administrative coordination necessary to participate in MIPS.”

MGMA had argued against the full-year quality reporting period for MIPS this year. In 2017, only a 90-day reporting period was required.

Determining eligibility isn’t as simple for clinicians as carrying over their 2017 participation status. As part of the Quality Payment Program (QPP) rule for 2018, CMS greatly increased their low-volume exemption thresholds. Clinicians won’t have to participate in MIPS if they see fewer than 200 Medicare patients (up from 100 in 2017) or receive less than $90,000 in Part B charges (up from $30,000). Additionally, clinicians can be exempt by special status as hospital-based or non-patient facing.

CMS didn’t immediately respond to a request for comment from HealthExec on why the notifications haven’t been sent out or when clinicians can expect to receive them.