MIPS Resources from ASPS
CMS has a general "MIPS Quick Start Guide" for program participation which can be found in their Resource Library.
Use this ASPS decision tree to keep track of how your practice structure impacts your MIPS score. You can also find definitions of these "special statuses" below.
2021 offers the option to opt-in to the MIPS program. Click here for more details.
ONLY small practices (15 or fewer providers) can report through Claims to earn points for Quality. You will need to report 6 measures for a full year of data (70% of your Medicare Part B patients for whom the measure applies, minimum 20 patients per measure, and 1 measure must be an outcome or high priority measure).
Special Status Definitions
CMS has designated "special statuses" to ease reporting burden for certain types of clinicians or practice settings. Review the descriptions for each special status to determine whether you qualify for reduced reporting requirements in certain performance categories. Not all these statuses are applied automatically, and some require an application through CMS.
2021 Designations for an Individual MIPS eligible clinician
| Special Status | Description |
|---|---|
| Small practice | A clinician associated with a practice that has 15 or fewer clinicians billing under the practice (TIN) during one of the 12-month segments of the MIPS determination period. |
| Health Professional Shortage Area (HPSA) | The clinician is associated with a practice that is in an area designated as an HPSA. |
| Rural | The clinician is associated with a practice that is in a zip code designated as rural, using the most recent Health Resources and Services Administration (HRSA) area health resource file data. |
| Facility-based | The clinician furnishes 75% or more of covered services in a hospital setting during one, or both 12-month review periods. CMS determines whether a service is hospital-based by analyzing standard claims transactions or use of Place of Service (POS) codes for:
|
| ASC-based | The clinician furnishes 75% or more of covered services in sites of service identified by code 24 in standard claims transactions during one, or both 12-month review periods. |
Source: About MIPS Participation, CMS QPP Resource Library. https://qpp.cms.gov/participation-lookup/about?py=2019
2021 Designations for a Practice (TIN level)
| Special Status | Description |
|---|---|
| Small practice | A group with 15 or fewer clinicians (NPIs) billing under the group's TIN during one/both 12-month review periods. |
| Health Professional Shortage Area (HPSA) | A group will be designated as an HPSA practice if more than 75% of the NPIs billing under the group's TIN are designated as an HPSA. |
| Rural | A group in a zip code designated as rural, using the most recent HRSA area health resource file data, and that has multiple practices under its TIN, with more than 75% of the NPIs billing under the group's TIN in a rural zip code. |
| Hospital-based | 100% of MIPS eligible clinicians associated with the group are designated as hospital-based during one or both 12-month review periods. If any MIPS eligible clinician in the group does not meet the individual hospital-based criteria, the group will not be designated as hospital-based. |
| ASC-based | 100% of MIPS eligible clinicians associated with the group are designated as ASC-based during one or both 12-month review periods. If any MIPS eligible clinician in the group does not meet the individual ASC-based criteria, the group will not be designated as ASC-based. |
Source: About MIPS Participation, CMS QPP Resource Library. https://qpp.cms.gov/participation-lookup/about?py=2019
Please contact Caryn Davidson, Quality Projects Manager, at quality@plasticsurgery.org or (847) 228-3349 to set up a consultation for your MIPS reporting needs as soon as possible.