The federal government granted an exclusion for many physicians to its Quality Payment Program (QPP), which features the Merit-based Incentive Payment System. Physicians – and other QPP-eligible clinicians - are omitted on the basis of billing less than $30,000 in Medicare Part B allowed charges per year OR providing care for less than 100 Part-B enrolled Medicare patients. According to estimates by the Centers for Medicare and Medicaid Services (CMS), this represents 35% of all eligible clinicians.
Some physicians may see so few Medicare patients, they may know they don’t have to be concerned with this new program. However, others may wonder whether they meet the exclusion. CMS recently announced that the agency will be mailing letters regarding the exclusion. Due in “late April through May,” the letters will be issued to your practice via your Medicare Administrative Contractor for Part B claims. CMS pledges that these notifications will be “providing the participation status of each MIPS clinician associated with your Taxpayer Identification Number (TIN).”
Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.
The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.
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