Frequently Asked Questions

Answer: If a clinician bills less than $30,000 in Medicare Part B allowable charges OR sees less than 100 Medicare Part B patients in a calendar year, the clinician is excluded from MIPS reporting. For example, if a surgeon bills more than $30,000 but only sees 2 Medicare patients, this clinician is considered excluded from MIPS reporting. CMS will be notifying the provider via letter that the provider is exempt for 2017 reporting for any specific TIN.
Answer: CMS started sending participation status letters out at the end of April, continuing through mid-May. These letters will contain all clinicians (NPIs) in a given tax ID, along with the MIPS participation status (whether you’re exempt, included, fell below the threshold, etc.).
Answer: Providers who enroll in Medicare at any point during the 2017 year are considered new and therefore are not eligible to report for MIPS.
Answer: The penalty for not reporting any data for the 2017 reporting year is a 4% negative payment adjustment in your 2019 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 2017 reporting, clinicians can incur a +/- 4% incentive in their 2019 Medicare Part B reimbursements. With respect to subsequent yearly reimbursements, the incentives will increase to 5% in 2020, 7% in 2021, and ultimately, +/- 9% in 2022 and beyond.
Answer: With the ‘Pick Your Pace’ option, MIPS allows clinicians to submit a minimum amount of data to Medicare and avoid the negative payment adjustment.
Answer: In order to avoid the negative payment adjustment, clinicians can report on 1 Quality measure, 1 improvement activity, or 4-5 required Advancing Care Information measures.
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: 50% 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: In order to avoid the negative payment adjustment, just one quality measure can be reported. However, it is ideal to report as many quality measures that apply.
Answer: Specialty sets are a group of measures that apply to clinicians in a specific specialty. If a clinician reporting for a specialty set doesn’t meet 6 measures, they should only report on the ones that apply.
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: -4% 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 ACI data: attestation, submitting through a QCDR, submitting via qualified registry, or submitting through an EHR. The ability to report ACI 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 2017, there is two measure set options for reporting Advancing Care Information. Those who have a 2015 certified edition, will report the advancing care information 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, 2018, since you will be reporting Advancing Care Information for one full year in 2018.
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 Advancing Care Information performance category, the group would combine their MIPS eligible clinicians’ performances under one Taxpayer Identification Number (TIN). Therefore, they are not calculated based upon one MIPS eligible clinician’s 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 (2017).
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.


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