Medical Billing Blog

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MIPS 2018 Overview and Assistance

By: Cal LaGroue

In previous posts, we have discussed the MIPS Eligibility Online Lookup Tool, where providers can enter their NPI numbers and find out their MIPS eligibility status. Well, the CMS has officially released a new version for 2018. With it, providers can discover their participation status for the MIPS 2018 performance year, and therefore determine whether or not they are eligible for financial incentives/penalties in 2020. Click the button below to utilize this tool

Reminder – The CMS has raised the eligibility threshold for 2018 to providers who:

  • accumulate $90,000 in Medicare Part B allowed charges


  • provide covered professional services to 200 Medicare Part B-enrolled beneficiaries

If you meet BOTH these requirements, you are eligible for participation in MIPS 2018. If you do not, you are exempt from participation in MIPS 2018. A more detailed explanation of the MIPS eligibility measuring system can be found below, under “How do I know if I meet the 2018 eligibility threshold?”.

Need a MIPS Refresher?


How do I know if I meet the 2018 MIPS eligibility threshold?

The CMS actually measures provider eligibility by looking at your numbers over the past 2 years. In order to be eligible for MIPS, you must have met the eligibility threshold (mentioned above) for two years in a row.

The CMS’ annual timeline begins September 1 and ends August 31 of the following year.

So, for MIPS 2018, the CMS looks at the following two 12 month periods:

  • September 2016 – August 2017
  • September 2017 – August 2018

If your numbers are below the eligibility threshold for the first time period, you are exempt from MIPS 2018. It doesn’t matter what your numbers are for the second period.

If your numbers are above the eligibility threshold for the first time period, you may still be exempt if you fail to meet the threshold for the second time period. You won’t know for sure until after August 2018.


Other Exemptions

You are also exempt from participation in MIPS 2018, if:

  • You are newly enrolled in Medicare as of 2018
  • Your practice is recognized as a Rural Health Clinic or a Federally Qualified Health Center
  • You are significantly participating in Advanced APMs, meaning you are receiving 25% of Medicare payments or seeing 20% of Medicare patients through Advanced APMs.*

* Advanced Alternative Payment Models (APMs) are a more extensive form of participation in the transition to Value-Based Care. Participation is strictly voluntary and reserved to providers who meet certain requirements. Financial incentives are available to providers who join. Click here for more information on Advanced APMs.


The Takeaway

Check your MIPS 2018 Participation Status using the button near the top of this post.

If you’re exempt, you have nothing to worry about.

If you’re eligible, reach out to your biller for more information about what to do. Or contact Valletta today! We can go over next steps with you.

Lastly, stay tuned to our blog. We at Valletta will continue to keep you informed about the various rules, exemptions, reporting methods, and deadlines for MIPS 2018.

About the Author: Cal LaGroue

Cal has over a decade of experience in the Revenue Cycle Management industry. He serves as Board Secretary for the Healthcare Business Management Association (HBMA), the leading organization for Revenue Cycle Management professionals. He's also accredited by the HBMA as a Certified Healthcare Business Management Executive (CHBME).

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