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January 13, 2020

Medicare MIPS error alert: recheck your final 2019 MIPS eligibility status

Due to errors discovered recently in the 2019 MIPS eligibility data, those who checked their eligibility status after Dec. 4, 2019, should recheck to confirm their final 2019 MIPS eligibility.
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The errors have been corrected and your status may have changed. Use the QPP Participation Status Tool to re-check and confirm your final 2019 Merit-based Incentive Payment System (MIPS) eligibility.

If you haven’t checked your final MIPS eligibility yet, you should do so now to understand your participation requirements for the 2019 performance period. The 2019 MIPS data submission period opened Jan. 2, 2020.

Checking your final 2019 MIPS eligibility

Your initial 2019 MIPS eligibility status was based on CMS review of Medicare Part B claims and Provider Enrollment, Chain, and Ownership System (PECOS) data from Oct. 1, 2017, to Sept. 30, 2018. Your final eligibility status is based on our reconciliation of this first review with a second review of Medicare Part B claims and PECOS data, from Oct. 1, 2018, to Sept. 30, 2019.

As a reminder, if, after the first review of your initial eligibility status earlier this year, you were determined to be:

  • Eligible for MIPS at a particular practice: Your eligibility status might have changed, and you may no longer be eligible at this practice.
  • Exempt from MIPS at a particular practice: You will remain exempt.

Please note, if you joined a new practice (meaning you assigned your billing rights to a new or different TIN) and billed Medicare services between Oct. 1, 2018, and Sept. 30, 2019, CMS evaluated your MIPS eligibility based on your association with that new practice (identified by TIN) exclusively during this second review.

If you joined a new practice after Sept. 30, 2019, you are not eligible for MIPS as an individual based on your association with that new practice (identified by TIN). However, you may be eligible to receive a MIPS payment adjustment based on your group’s participation, if the new practice you joined chooses to participate in MIPS as a group.

Questions? Contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8 a.m.- 8 p.m. EST or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours — before 10 a.m. and after 2 p.m. Customers who are hearing impaired can dial 711 to be connected to a TRS communications assistant.

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