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The previous article, “Lookup Tool for Quality Payment Program MIPS Participation Status” has been updated for 2018. Last update May 21, 2018.

CMS MIPS Participation Lookup Tool Updates

CMS has released an update to the CMS MIPS Participation Lookup Tool for clinicians and groups to check on 2018 eligibility for the Merit-based Incentive Payment System (MIPS) and now displays a clinician’s hospital based and patient facing status. Plan now in 2018 to earn a positive payment adjustment in 2020.

Using the MIPS eligibility tool is easy

Looking up your MIPS eligibility status is as easy as entering your National Provider Identifier (NPI) in the search field. The next screen will then explain whether you need to participate during the 2018 performance year. The portal will display details about the clinician and their associated Tax Id Numbers (TINs). For each associated TIN, the portal will display the clinician’s QPP participation status, patient facing classification, and hospital based status.

As a reminder, clinicians classified as non-patient facing or hospital based are excluded from reporting the Advancing Care Information (now, Promoting Interoperability) category of MIPS. Non-patient facing clinicians also have reduced reporting requirements for the Improvement Activities Category, 1 high weighted or 2 medium weighted activities.

CMS Updates Low-Volume Threshold for 2018

CMS reduced the burden on smaller practices by changing the eligibility threshold for 2018. Clinicians and groups are excluded if they:

  • Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule (PFS) – OR –
  • Furnished covered professional services under the PFS to 200 or fewer Medicare Part B-enrolled beneficiaries

You need to have billed more than $90,000 in Medicare Part B allowed charges for covered professional services under the PFS and furnished covered professional services under the PFS to more than 200 Medicare Part B enrolled beneficiaries to be included in MIPS for the 2018 performance period. CMS estimates more can 500,000 clinicians will be exempt from MIPS for this performance period based on the new threshold requirements. MIPS is one of the two payment pathways for clinicians and groups under the Medicare Access and CHIP Reauthorization Act of 2015. In case you are wondering about the Alternative Payment Model (APM), CMS has not released an update yet but has plans to. The MIPS tool does not reflect 2017 or 2018 participation for the APM model.

The abeo team of experts assists our client with their questions about the Quality Payment Program (QPP).  Clients should contact their Client Relation Manager (CRM) with questions about participation agreements or opt-out forms.  Contact us if you would like more information or visit


abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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