Merit-Based Incentive Payment System (MIPS) Support Services

Expert support and submission services to help MIPS eligible providers meet Quality Payment Program requirements and optimize Medicare payments.

Sponsor: Centers for Medicare & Medicaid Services (CMS); NJII offers paid support services through its for-profit subsidiary

Geographic Scope: United States (U.S. healthcare providers)

Service Type: Paid consulting service (not a grant program)

Eligible Clients: U.S. healthcare providers who:

• Bill more than $90,000 to Medicare in allowable charges AND
• Provide care to more than 200 Medicare patients per year AND
• Cover more than 200 professional services during the performance period

Eligible Clinician Types:

• Physicians (MD, DO, DDS, DMD, DPM, OD, Chiropractors)
• Physician Assistants (PAs)
• Nurse Practitioners (NPs)
• Clinical Nurse Specialists
• Certified Registered Nurse Anesthetists
• Clinician groups including any of the above
• Clinical Psychologists
• Physical Therapists
• Occupational Therapists
• Speech-Language Pathologists
• Audiologists
• Registered Dietitians or Nutrition Professionals

MIPS Requirements:

• Must participate to avoid negative adjustment to Medicare Part B payments
• Can earn upward payment adjustments
• Can participate individually or as part of group
• Collect performance data for services furnished beginning January 1 through December 31

Exemptions from MIPS:

1. Clinicians in first year of Medicare Part B participation
2. Clinicians billing Medicare Part B up to $90,000 or serving up to 200 Part B patients or covering up to 200 professional services in one year
3. Clinicians in entities sufficiently participating in Advanced APM:
   • Receive 50% of Medicare Part B payments through Advanced APM OR
   • See 35% of Medicare patients through Advanced APM

Voluntary Participation for Non-Eligible Clinicians:

• Non-eligible clinicians may voluntarily submit data to CMS
• No positive or negative payment adjustment
• Helps clinicians learn, obtain feedback, and prepare for future MIPS expansion

Opt-In Policy:

• Available for MIPS eligible clinicians excluded based on low-volume threshold
• If meet or exceed at least one (but not all) low-volume threshold criteria, may opt-in
• Subject to MIPS performance requirements and payment adjustments once elected
• Decision is irrevocable

Performance Period Determination:

• For 2020 MIPS performance period and 2022 payment year: low-volume status based on either evaluation period:
  • Historical claims data: October 1, 2018 – September 31, 2019
  • Performance period claims data: October 1, 2019 – September 31, 2020

NJII Support Services:

• CMS qualified registry submission
• MIPS advisory services
• Data collection and management support
• Email contact form available on website

How to Engage NJII MIPS Support Services

1. Registration: Register to submit through NJII's CMS qualified registry
2. Consultation: Hire NJII MIPS advisers to help through the process
3. Service Options:
   • Submit data through NJII's CMS qualified registry
   • Receive advisory support on MIPS participation

Contact Process:

• Use the inquiry form on the MIPS Eligibility page if you have additional questions
• Direct contact with NJII Healthcare team

Required Information (Typical):

• Organization details
• Practice/facility information
• Number of Medicare patients served
• Medicare billing amounts
• Professional services covered