Navigating MIPS Exemptions and Special Statuses: Who Qualifies and How to Apply
Mastering the nuances of MIPS exemptions and special statuses can significantly alleviate the compliance burdens for healthcare providers. This detailed guide explains the criteria for exemptions, describes various special statuses, and details the application process.
Who Qualifies for MIPS Exemptions?
Low-volume Threshold:
Providers with less than $90,000 in Medicare Part B allowed charges OR fewer than 200 Medicare Part B beneficiaries OR fewer than 200 covered professional services.
Newly Enrolled in Medicare:
Providers who enrolled in Medicare for the first time during the performance year are automatically exempt from MIPS for their first year.
Significant Hardship Exceptions:
Providers may qualify due to significant hardships such as major natural disasters, severe lack of sufficient Internet access, or significant issues with CEHRT availability.
Special Statuses Under MIPS:
Small Practice:
Practices with 15 or fewer clinicians receive additional points to their final score and can have the Promoting Interoperability performance category reweighted to zero if they do not report any data for this category.
Rural Practice:
Practices located in rural areas are often provided scoring considerations due to the unique challenges they face in healthcare delivery.
Health Professional Shortage Area (HPSA):
Practices in designated HPSAs may receive additional support or modified scoring adjustments.
Non-patient Facing:
Clinicians who have 100 or fewer patient-facing encounters during the performance period are considered non-patient facing and may be exempt from the Promoting Interoperability category.
Hospital-Based:
Clinicians who provide 75% or more of their covered professional services in hospital settings (inpatient, on-campus outpatient, or emergency room) are considered hospital-based and may be exempt from the Promoting Interoperability category.
Ambulatory Surgical Center (ASC)-Based:
Clinicians who perform 75% or more of their covered professional services in an ASC are considered ASC-based and are exempt from the Promoting Interoperability category.
How to Apply for Exemptions and Special Statuses:
Check Eligibility:
Review detailed eligibility criteria on the CMS Quality Payment Program website.
Submit Application:
Apply for hardship exceptions or check your special status automatically through the Quality Payment Program portal, typically by December 31 of the performance year.
Document Everything:
Keep detailed records and documentation to support your application, which may be necessary for audits by CMS
Proper understanding and utilization of MIPS exemptions and special statuses can greatly alleviate the burden of MIPS compliance. Correct application and thorough documentation are crucial to successfully navigating these options, ensuring that eligible providers can focus more on patient care and less on administrative burdens. Make sure you are prepared and avoid a MIPS Penalty! Contact us at 803-215-2544 to get started today.
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