In our last blog, we covered the two main paths through which to participate through MACRA: MIPS and advanced APMs. We also mentioned that initially, most practitioners won’t be able to transition to the APM model. The majority of clinicians will therefore be subject to MIPS, which will adjust traditional fee-for-service payments upward or downward based on the new reporting program.  healthcare-professionals

So Who, Exactly, is Subject to MIPS?

The MIPS regulations apply to clinicians only, and not to hospitals. Affected Medicare Part B clinicians who will participate in MIPS will be called “MIPS eligible clinicians.” Eligible clinicians (EC) can report as individuals or as a group.

As of now, in the first two years of MACRA, MIPS eligible clinicians will include physicians (MDs/DOs), PAs, NPs, clinical nurse specialists, CRNAs, optometrists and chiropractors. Likely in the new program’s third year or after, MIPS eligible clinicians will include OTs, PTs, SLPs, audiologists, nurse midwives, clinical social workers, clinical psychologists, dieticians/nutritionists and other nutritional professionals.

Who is excluded from MIPS?

  • Clinicians in their first year of Medicare Part B participation
  • Clinicians who have billing charges less than or equal to $10,000 or provide care for 100 or fewer Medicare patients per year
  • Certain qualifying advanced APM participants

In our next MACRA-related blog installments, we will break down the components of MIPS and its performance categories.


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