Will you be excluded from MIPS? CMS clarifies low-volume exemption proposal for 2018

The Advocacy Council attended a briefing given by CMS in Washington on July 20 regarding Year 2 of the Merit-based Incentive Payment System (MIPS), which begins in 2018. The briefing provided clarification on the CMS proposal that came out earlier this summer.

We believe the majority of allergists will be excluded from MIPS because of the expansion of the exemption for low-volume providers. If the proposal is finalized, physicians with allowable Medicare charges of $90,000 or less, OR 200 or fewer Medicare patients per year, will be exempt and will not have to report under MIPS. However, CMS made some important clarifications about the scope of the exemption.

First, CMS explained that it will continue to apply the exemption to groups, the same as it applies to individual physicians. This means that if a physician is in a group and bills through the group, the entire group’s revenue or number of patients will count in determining if the exemption is met. However, if the physician bills individually, only his/her own Medicare- allowed charges or patients will count. Allergists should consider this option if they would qualify individually for the exemption but not as a group.

Second, CMS clarified they will count claims for Part B drugs in determining whether a physician is under the $90,000 threshold. So, if an allergist submits a claim to Medicare that includes Xolair or IVIG, for example, those revenues will be counted.

CMS will be sending a letter to physicians towards the end of the year letting them know if they are exempt. CMS will base the determination on the prior year claims.  If you are exempt, you cannot participate in MIPS even if you want to. However, CMS is proposing to change this to allow physicians to “opt-in.”  This would allow physicians who want to participate to be able to qualify for MIPS bonuses. However, this change, even if adopted, will not be put into place until 2019 at the earliest.

The Advocacy Council will be submitting comments to CMS on the MIPS Year 2 proposal. We welcome your comments and feedback. For help on MIPS reporting for 2017, check out our MIPS toolkit.

Advocacy Issue: 
Billing, Coding & Payments