MIPS 2023 Participation Status: Do I Have To Report?

Are you one of the MIPS 2023-eligible clinician types? Certainly, you might be familiar with the utmost significance of retaining MIPS eligibility. Twice a performance year, CMS updates the MIPS participation status. At first, clinicians get their initial eligibility status. Then, they get their final eligibility status. So, it’s time for MIPS 2023 clinicians to check for their final MIPS eligibility. CMS has recently updated the eligibility status for MIPS 2023 reporting. And as the submission window is open for MIPS reporting, it’s high time to check your participation status. Today’s blog brings insightful information for all MIPS participants who’ve taken part this year.

Let’s delve down to understand MIPS eligibility thoroughly. Also, it will be helpful for them to determine their reporting requirements.

MIPS 2023 Participation Status

According to the MIPS framework, only eligible clinicians can participate in MIPS. Thinking about who these eligible clinicians are? CMS provides a list of clinician types who have to take part in MIPS reporting. However, this is not all; these clinicians have to strive hard to retain their eligibility. At any stage, if they fail to meet the reporting requirements, they can face immediate exemption. MIPS initial eligibility is a green flag to enter the respective performance period. Likewise, MIPS’s final eligibility gives them a ticket for entering the reporting period.

Eligible Clinician Types for MIPS 2023

Here we have listed those clinician types considered eligible in the PFS final rule for PY 2023:

• Medical professionals (including doctors of medicine, osteopathy, dentistry, dental medicine, podiatric medicine, and optometry)
• Osteopathic doctors
• Chiropractors
• Medical assistants
• Licensed practical nurses
• Clinical nurse specialists
• Registered nurse anesthetists (certified)
• Physical therapists
• Occupational therapists
• Licensed clinical psychologists
• Qualified audiologists
• Qualified speech-language pathologists
• Registered dietitians and nutritionists
• Social workers in clinical settings
• Nurse midwives (certified)

Now, we are familiar with “types” for MIPS 2023 clinicians. Let’s see what criteria CMS applies for your 2023 eligibility statuses.

MIPS-eligibility Determination Criteria

Your MIPS 2023 eligibility depends on:

1. Specific clinician type
2. Your enrollment date as a Medicare provider
3. The volume of care you deliver (to all of your Medicare Part B-eligible patients)
4. Your level of participation in an Advanced APM (your Qualifying APM Participant (QP) status)

The Significance of Checking Your MIPS Participation Status

• The MIPS participation status depicts how you can appear in MIPS 2023 reporting. It clarifies whether you’re eligible to report as an individual or as part of a group. All you need to check your status is your correct NPI and Tax Identification Number (TIN).
• Usually, some providers associate their TIN with multiple practices. So, in this case, they might have to participate in MIPA for more than one practice. However, when checking their participation status, they can get eligibility updates easily.
• Moreover, if you get any special status in MIPS, the CMS tool lists every detail in just a few seconds. Remember, your eligibility and special status are linked with your claims’ review and PECOS data. More specifically, your Provider, Enrollment, Chain, and Ownership System (PECOS) data from October 1, 2022 to September 30, 2023 is considered.
• In addition to this, the QPP Status Tool also informs you about your opt-in ability for MIPS.

Keep it in Mind!

A MIPS eligibility check is a must for every TIN or practice for which you’re submitting Medicare claims. Likewise, check out your APM participation status along with your MIPS status.

How does CMS Determine the Volume of Care you Provide?

As stated earlier, your Medicare Part claims and PECOS data are something else. After evaluating this data during two determination periods (12 months each), CMS determines the volume of care you provide to Medicare beneficiaries.

Remember!

Your MIPS eligibility depends on your MIPS performance. You have to exceed the low-volume threshold criteria of MIPS 2023 to retain eligibility. Also, this applies for both parts of the determination period.

Various factors can influence your MIPS eligibility. For instance, joining or leaving a practice may have an impact on eligibility status. Therefore, we recommend you keep a check on your MIPS eligibility.

Now think! What if you could not retain your eligibility during the first determination period? Simply put, it means you will not be a part of MIPS anymore. The eligibility status won’t alter in the second determination period. However, you elect to take part in MIPS 2023 as an opt-in participant in some scenarios.

What Now?

Check out your participation status for MIPS 2023. The submission period has begun. Enter your NPI in the QPP participation tool and check your MIPS eligibility for the 2023 data submission and MIPS 2024 performance year.