2018 MIPS Eligibility

Who Participates in MIPS?

You are eligible to participate in the MIPS track of the Quality Payment Program if you bill more than $90,000 to Medicare in allowable charges, AND provide care to more than 200 Medicare patients per year, and you are one of the following clinicians:

  • Physicians, which includes doctors of medicine, doctors of osteopathy (including osteopathic practitioners), doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors
  • Physician assistants (PAs)
  • Nurse practitioners (NPs)
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Any clinician group that includes one of the professionals listed above

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What Should You Do?

If included in MIPS, the clinician:

  • Must participate to avoid a negative adjustment to their Medicare Part B payments and potentially earn an upward adjustment.
  • Can participate as an individual or as part of their group.
  • Collect performance data for services that were furnished beginning on January 1, 2018 until December 31, 2018.

Performance Determination

For the 2018 MIPS performance period and the 2020 MIPS payment year, CMS will make low-volume status determinations based on satisfying either low-volume threshold in either one of the following evaluation periods:

  • Historical claims data: September 1, 2016 – August 31, 2017
  • Performance period claims data: September 1, 2017 – August 31, 2018


For the CY 2018 performance year, there are three exemptions from MIPS for clinicians who otherwise meet the eligibility requirements above:

  • Clinicians in their first year of Medicare Part B participation
  • Clinicians billing Medicare Part B up to $90,000 in allowable charges or providing care for up to 200 Part B patients in one year
  • Clinicians in entities sufficiently participating in an Advanced APM for which either:
    • You receive 25% of your Medicare Part B payments through an Advanced APM or
    • See 20% of your Medicare patients through an Advanced APM

Voluntary Participation for Non-Eligible MIPS Clinicians

Clinicians who are not included in MIPS for the 2018 reporting year, may choose to voluntarily submit data individually to Medicare to learn, obtain feedback on quality measures, and prepare in the event MIPS is expanded in the future. Clinicians who submit data voluntarily will not be subject to a positive or negative payment adjustment.

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