CMS Offers Providers a Way to Check Status for 2018 MIPS

CMS recently made a lookup tool available for providers to check on their 2018 MIPS Participation Status.  With this tool (link here) providers can put their NPI into the space provided and, after choosing, can look up whether they might possibly be exempt from MIPS or whether CMS states they must participate in 2018.  Remember that the maximum penalty related to 2018 participation in the Quality Payment Program (QPP) is up to 5% and reductions take place in the year 2020.

CMS is careful to note that if a provider is a participant in a 2018 APM (Alternative Payment Model) or Track 1 of the Medicare Shared Savings Program under QPP, the 2018 APM information is not uploaded or searchable as of this writing.  CMS notes this portion of the Lookup Tool may be available sometime in late Spring, 2018.

CMS also noted that in 2017, the APM and “Shared Savings” information, if different, over-ruled the 2017 MIPS information.  They make no comment on this for 2018 at this time.  We note that few eye care providers are in APMs or “Shared Savings”, so this won’t impact many ophthalmologists or optometrists.

CMS also carefully makes the following point:

“Please note that the MIPS Participation Status Tool is only a technical resource and not dispositive as to any eligible clinician’s or group’s status under MIPS. For more information, we refer users to the Quality Payment Program regulations at 42 C.F.R. part 414 subpart O.”

IMPORTANT:  It is wise to take a screenshot of the lookup results you receive via the Tool and print and save this information where it will be retrievable.  It would also be wise to have the time-and-date stamp or include this information in some way when you do this.  If the results via the Lookup Tool are not what you expect, such as when you have a busy Medicare Part B provider who shows as exempt from QPP in 2018, then you should contact CMS immediately to verify it.  CMS provides a phone number for this on the QPP Help and Support page (866-288-8292) and also provides an email address for this purpose (  Make notes of any phone conversations you have with CMS officials and save all correspondence related to this important topic.

We are happy to assist providers and groups in any way with QPP, MIPS, and other topics including chart reviews, payer actions, and training on these or other subjects.  Please contact us via one of the below links or on our “App”, Corcoran 24/7, which can be accessed via one of the links below.   (800) 399-6565

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