The lookup tool is available on the Quality Payment Program website. To use it, an individual provider need only enter his or her 10-digit NPI. The lookup tool then generates a personalized report for the provider, stating whether he or she is excluded from MIPS under the low-volume threshold.
Specifically, the report lists each TIN under which the provider bills for Part B services. Then, for each TIN, the report states whether the provider would meet the low-volume threshold if: (1) he or she elects to report individually; or (2) the TIN reports as a group. In the case of the latter, the provider will be subject to MIPS, even if he or she would be excluded if reporting individually.
Keep in mind these MIPS reports are based on the first review period only. If a provider is exempt from MIPS for the first review, he or she will not need to do anything else related to MIPS reporting for this calendar year. If a provider is included in MIPS with the first review, he or she may be exempt with the second review of eligibility determinations at the end of 2017.
The lookup tool does not report a provider’s status with regard to the two other MIPS exceptions: (1) first-year participation in the Medicare program; and (2) participation in an Advanced Alternative Payment Model (APM).
According to news reports, 418,849 physicians and non-physician practitioners will be included in MIPS in 2017, and thus will be required to report performance data to avoid a 4% penalty on their 2019 Medicare Physician Fee Schedule payments. Another 806,879 physicians and non-physician practitioners will be exempt from MIPS requirements.
In publishing the MIPS final rule last fall, CMS stated the low-volume threshold will be less generous in future years, meaning more physicians will be subject to MIPS. We should know the numbers for next year soon, as CMS forwarded a proposed rule on 2018 MIPS updates to the Office of Management and Budget in late March, the last step prior to publication in the Federal Register.