Merit-Based Incentive Payment System (MIPS) Support Services

Merit-Based Incentive Payment System (MIPS) Support Services

Overview: 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

Contact: NJII Healthcare Division

Email contact form available on website