>>Molly MacHarris: Who
participates in the merit-based incentive
payment system? I’m Molly MacHarris with
CCSQ, and I will be leading you through this discussion. So, who is eligible to
participate under the MIPS program? Those clinicians that are
eligible include physicians, physician assistants, nurse
practitioners, clinical nurse specialists, and
certified registered nurse anesthetists. Please note that, when we
talk about physicians here at Medicare, we mean not
only M.D.s and D.O.s, but we also mean dentists
pediatrists, and optometrists. Additionally, we have
certain levels of exclusions under the MIPS program. The first exclusion that
everyone should be aware of is that if a clinician bills
more than 30,000 annually and provides care for more
than 100 patients, they are eligible to participate
in the MIPS program. There are some additional
exclusions that we have available under the MIPS
program, which include clinicians who are newly
enrolled in Medicare. So, if the very first time
you become enrolled in Medicare — if that’s during
2017, which is the initial performance period —
you are not eligible to participate in MIPS. You would, however, be
eligible to participate in a future here. The third exclusion on the
slide, on the right-hand side, deals with significant
participation and advanced APMs. We have more information on
how to meet this exclusion under other training modules
which will be offered, so I would encourage folks to
take a look at the training modules that deal with
participation through APMs. And then the middle
exclusion I touched on just a little bit earlier, which
is the low-volume threshold. I do want to note something
here, which deals with the 30,000 or 100 patients. And you’ll recall from the
previous slide, it listed 30,000 and 100 patients. And I think, if we advance
to the next slide, there is an example for this. So, the example is: “I would
like to know whether I’m exempt from the MIPS if I
exceed either the physician fee schedule charges or the
beneficiary count, but not both.” So, we wanted to be really
clear to everyone on exactly how this will work, because
I can understand why it can be confusing where, in some
instances, we say that these two elements either/or have
to be met, but then in some instances they both
have to be met. And it gets into a bit of
a double negative, so I apologize in advance. But the way that it works
is that, when you’re talking about who is eligible to
participate — meaning, from the positive end — it’s an
“and,” meaning clinicians would need to have 30,000
in billing and see more than 100 patients. When you talk about it from
the negative end, however — meaning, from who is
excluded — it’s an “or.” So, clinicians are excluded
if they see less than or equal to 30,000 or less than
or equal to 100 patients. We have an example on this
slide here, that provides a scenario where a
clinician would be exempt. So, their billing is 29,000
and they see 101 patients. So, then, they
would be exempt. There are a couple
additional eligibility scenarios that all eligible
clinicians should be aware of. An additional eligibility
scenario deals with those clinicians who are
considered to be non-patient-facing. Non-patient-facing
clinicians are typically pathologists and certain
types of radiologists. There also are a few
other specialties as well. Non-patient-facing
clinicians are eligible to participate under
the MIPS program. In some instances, however,
they have different scoring rules that would be
applied under some of the performance categories. Thank you for viewing
this presentation. For more information, please
visit the Quality Payment Program website
at qpp.cms.gov.

Who Participates in the Merit-based Incentive System?
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