MIPS Low-Volume Threshold Criteria for 2021 and Participating Through the Opt-In or Voluntary Reporting Options


Check Final 2021 MIPS Eligibility Status

You can now visit the Quality Payment Program (QPP) Participation Status Tool and review your final 2021 eligibility status for the Merit-based Incentive Payment System (MIPS). We’ve updated your eligibility status based on our review of Medicare Part B claims and Medicare Provider Enrollment, Chain, and Ownership System (PECOS) data from the second segment of the MIPS Eligibility Determination Period (October 1, 2020 – September 30, 2021).

  • This status is final unless you participate in an Advanced Alternative Payment Model (APM) and your Qualifying APM Participant (QP) status changes as a result of the 3rd APM Snapshot for performance year 2021.
  • Results from the 3rd APM Snapshot will be available in December 2021 and will be announced through the QPP listserv.

Review Your 2021 Eligibility

Your status may have changed, so we encourage you to use the QPP Participation Status Tool to confirm your final 2021 MIPS eligibility status.

If, after a review of the data from the first segment of the MIPS Eligibility Determination Period (October 1, 2019 – September 30, 2020), you were determined to be:

  • Eligible for MIPS: Your eligibility status could have changed, and you may no longer be eligible. You should use the tool to make sure you’re still eligible.
  • Not eligible for MIPS at a particular practice: Your eligibility status, based on your association with that particular practice, didn’t change.

Please note, if you joined a new practice (meaning you billed under, or assigned your billing rights to, a new or different Tax Identification Number (TIN)) between October 1, 2020, and September 30, 2021, we evaluated your MIPS eligibility status based on your association with that new practice (identified by TIN) for this second review.

If you’re a clinician that joined a new practice after September 30, 2021, you aren’t eligible for MIPS as an individual based on your association with that new practice (identified by TIN). However, you may be eligible to receive a MIPS payment adjustment based on your group’s participation, if the new practice you joined chooses to participate in MIPS as a group.

For More Information

Please visit the MIPS Participation Options Overview webpage on the Quality Payment Program website and check out the following resources:


MIPS Low-Volume Threshold Criteria for 2021 and Participating Through the Opt-In or Voluntary Reporting Options

Clinicians and groups are excluded from MIPS for 2021 if they:

In order to be eligible for MIPS, a clinician or group must exceed all 3 criteria listed above. You can check the Quality Payment Program (QPP) Participation Status Tool to view your final 2021 eligibility status for MIPS.

Participation Options for Clinicians and Groups Not Eligible for MIPS

Clinicians and groups who aren’t eligible for MIPS can still report data via traditional MIPSClinicians and groups who are identified as “opt-in eligible” on the QPP Participation Status Tool have exceeded 1 or 2 of the low-volume threshold criteria noted above and have at least one clinician who:

  • Is identified as a MIPS eligible clinician type on Medicare Part B claims;
  • Enrolled as a Medicare provider before 2021; and
  • Isn’t a QP.

Opt-in eligible clinicians and groups who wish to report data via traditional MIPS can:

  • Elect to Opt-in to MIPS. You’ll receive a MIPS payment adjustment (positive, negative or neutral).
    • Note: Once you make your election, your election is binding and irreversible.
  • Voluntarily Report. You won’t receive a MIPS payment adjustment (no election is required to voluntarily report data to MIPS).

Clinicians and groups who are excluded from MIPS and aren’t “opt-in eligible” because they fall below all 3 of the low-volume threshold criteria may choose to voluntarily report data to MIPS but won’t receive a MIPS payment adjustment.

Note: MIPS APM Participants who are “opt-in” eligible also have the option to elect to opt-in and report using the APM Performance Pathway (or APP).

Next Steps

Before reporting data, opt-in eligible clinicians and groups who wish to submit data will need to complete an election to opt-in or voluntarily report in MIPS by signing in to the QPP website. Qualified Registries and Qualified Clinical Data Registries (QCDRs) can also submit elections on behalf of these clinicians and groups. Elections can be made once the 2021 MIPS submission period opens on January 3, 2022.

For More Information

Visit the Reporting Options Overview webpage on the Quality Payment Program website. The 2021 MIPS Opt-In Reporting and Election Process Toolkit will be available on the QPP Resource Library by the start of the submission period.


Check Your Initial 2022 MIPS Eligibility on the QPP Website

You can now use the Quality Payment Program Participation Status Tool to check your initial 2022 MIPS eligibility status.

  • Just enter your National Provider Identifier (NPI) to find out whether you need to participate in MIPS during the 2022 performance year.

Low-Volume Threshold Requirements

To be eligible to participate in MIPS in 2022, you must:

  • Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS); AND
  • Furnish covered professional services to more than 200 Medicare Part B beneficiaries; AND
  • Provide more than 200 covered professional services under the PFS.

If you don’t exceed all 3 of the above criteria for the 2022 performance year, you’re excluded from MIPS. However, you have the opportunity to opt-in to MIPS and receive a payment adjustment if you meet or exceed 1 or 2, but not all, of the low-volume threshold criteria. Alternatively, you may choose to voluntarily report to MIPS and not receive a payment adjustment if you don’t meet any of the low-volume threshold criteria or if you meet some, but not all, of the criteria.

Please note, CMS now evaluates the low-volume threshold for MIPS Alternative Payment Model (APM) participants at the individual or group level, just as it does for participants who aren’t in MIPS APMs. CMS no longer evaluates APM Entities for eligibility against the low-volume threshold.

Find Out Today

Find out today whether you’re eligible for MIPS. Prepare now to earn a positive payment adjustment in 2024 for your 2022 performance.

Note: The QPP Participation Status Tool will be updated with clinicians’ QP status 3 times during the performance year.

Questions?

Please contact the Quality Payment Program at 1-866-288-8292 (Monday-Friday 8 a.m.- 8 p.m. ET) or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET.

  • Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.


You’re getting this message because you subscribed to get email updates from the Centers for Medicare & Medicaid Services (CMS).

Update your subscriptions, modify your password or email address, or stop subscriptions at any time on your Subscriber Preferences Page. You will need to use your email address to log in. If you have questions or problems with the subscription service, please contact subscriberhelp.govdelivery.com.

This service is provided to you at no charge by Centers for Medicare & Medicaid Services (CMS).


GovDelivery Communications Cloud 7500 Security Boulevard · Baltimore MD 21244

Leave a Comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s