Frequently Asked Questions

Answer: If a clinician bills less than $90,000 in Medicare Part B allowable charges OR sees less than 200 Medicare Part B patients in a calendar year, the clinician is excluded from MIPS reporting. For example, if a surgeon bills more than $90,000 but only sees 2 Medicare patients, this clinician is considered excluded from MIPS reporting.
Answer: In order to find out if you are eligible for the 2018 program year you will need to look up by NPI on Quality Payment Program website by going to
Answer: Clinicians who enroll in Medicare at any point during the 2018 year are considered new and therefore are not eligible to report for MIPS.
Answer: The penalty for not reporting any data for the 2018 reporting year is a 5% negative payment adjustment in your 2020 Medicare reimbursements.
Answer: A: The NJII MIPS team will verify your data before it is sent to CMS. They will also provide support over the phone or email to ensure you meet CMS requirements.
Answer: MIPS incentives and penalties will gradually increase over the next few years. With respect to 2018 reporting, clinicians can incur a +/- 5% incentive in their 2020 Medicare Part B reimbursements. With respect to subsequent yearly reimbursements, the incentives will increase to 7% in 2021, and ultimately, +/- 9% in 2022 and beyond.
Answer: MIPS allows clinicians to submit a minimum amount of data for 15 points to Medicare and avoid the negative payment adjustment.
Answer:  In order to avoid the negative payment adjustment, clinicians can report on all required Improvement Activities, meet the Advancing Care Information base score AND submit 1 Quality measure that meets data completeness, meet the Advancing Care Information base score by reporting 5 base measures AND submit ONE medium-weighted Improvement Activity or submit 6 Quality measures that meet data completeness.
Answer: The Quality category of MIPS replaces the PQRS program. The difference between PQRS and MIPS is the change in reporting requirements. The process of collecting data remains the same.
Answer: 60% of all patients (including Medicare Part B, and non-Medicare Part B).
Answer: Measure groups are no longer a reporting option under MIPS.
Answer: 6 measures need to be reported on, of which one must be an outcome measure; if no outcome measure is applicable, then one high priority measure can be reported instead. Alternatively, eligible clinicians can choose to report measures in a specialty set.
Answer: No, there are no longer domain restrictions for quality measures.
Answer: Under MIPS, there are no longer any cross-cutting measures.
Answer: If you are not able to work on the 6 quality measures that are required then the clinician or group will be subjected to the Eligible Measures Applicability (EMA) process to determine if the clinician or group could have reported more.
Answer: Specialty sets are a group of measures that apply to clinicians in a specific specialty. A clinician may choose to report on a specialty measure set. If they report on a specialty measure set that has less than 6 measures included they do not need to report on any additional measures.
Answer: Three types are possible: positive, neutral, or negative.

  • Positive adjustment: given to providers whose performance is exemplary.
  • Neutral adjustment: given to providers who submit the minimum amount of data.
  • Negative adjustment: -5% penalty given to providers who fail to report.
Answer: Yes! Data abstraction is included with NJII’s consulting service package.



Answer: There are four mechanisms you can choose from to report your PI data: attestation, submitting through a QCDR, submitting via qualified registry, or submitting through an EHR. The ability to report PI measures via Registry and QCDR is new under MIPS, and for consolidation of reporting, you must submit for all categories through a single submission mechanism.
Answer: In 2018, there is two measure set options for reporting Promoting Interoperability. Those who have a 2015 certified edition, will report the Promoting Interoperability measures and objectives, and those who have a 2014 certified edition will report on the advancing care information transition measures and objectives. Note, in both cases, clinicians may report on a combination of both measure sets. The option you’ll use to send in data is based on your Certified EHR Technology Edition.
Answer: By January 1, 2019 your practice will need to be on a 2015 certified version in order to report the measures included in the Promoting Interoperability category.
Answer: Under MIPS, there are no thresholds tied with the measures. For the base score, a 1 in the numerator is needed on all base measures. For the performance score measures, clinicians should strive to achieve high performances in order to receive the maximum amount of points.
Answer:  When reporting as a group to the Promoting Interoperability performance category, the group would combine their MIPS eligible clinicians’ performances under one Tax Identification Number (TIN). Therefore, they are not calculated based upon one MIPS eligible clinicians performance.
Answer: No. You will report your quality data for MIPS as a separate category (QUALITY).
Answer: You must attest by indicating “yes” to each activity that meets the 90-day requirement; in other words, activities that you performed for at least 90 consecutive days during the current performance period (2018).
Answer: Improvement activities are assessed on the TIN level. Therefore, as long as one eligible clinician reports, the entire group gets credit for that category.


Answer: The Cost performance category uses your Medicare claims data to collect Medicare payment information for the care you gave to beneficiaries during a specific period of time. Because CMs will use Medicare claims data, the Cost performance category score will be automatically calculated on their end and you will not have to submit any data.
Answer: For year 2018, two cost measures will be used to measure performance:

  • Total Per Capita Cost Measure
  • Medicare Spending Per Beneficiary measure

For details on how the final MIPS Cost score is calculated please visit the link below:

Answer: The cost category requires a minimum of 20 eligible cases for the total per capita cost measure, or 35 cases for MSPB measure. In case minimums aren’t met for either of the 2 measures, CMS will reweigh the Cost performance category weight to the Quality performance category. This will make the Quality performance category worth 60% of your 2018 MIPS total score.

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