Quality Payment Program Look-Up Tool For 2018 MIPS Eligibility and Predictive Qualifying APM Participant Data

June 14th, 2018

On June 14 the Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Look-Up Tool to allow providers to see their 2018 Merit-based Incentive Payment System (MIPS) eligibility and Alternative Payment Model (APM) Qualifying APM Participant (QP) data. the Quality Payment Program Participation Status Tool was previously called the MIPS Participation Status Tool.

Just enter your National Provider Identifier (NPI) in the tool to find out:

  • Whether you need to participate in MIPS in 2018
  • Your Predictive QP status

Note: The Predictive QP status is based on calculations from claims with dates of service between 1/1/17 and 8/31/17.  IMPORTANT:  If you used dates of service from 9/1/17 through 12/31/17, your Predictive QP status will NOT be correct.

CMS determined Predictive QP status using the following analysis:

  • Identified eligible providers participating in Advanced APMs using the APM Entity participation lists.
  • Identified attribution-eligible beneficiaries from Medicare Parts A and B administrative claims data and Medicare beneficiary enrollment information.
  • Identified beneficiaries attributed to Advanced APM Entities.
  • Calculated payment amount Threshold Scores.
  • Calculated patient count Threshold Scores.
  • Determined predictive QP or Partial QP status for an APM Entity group based on the payment amount or patient count.
  • CMS applied the more advantageous QP Status to the eligible providers participating in the APM Entity.

Providers Can Also Check 2018 MIPS check group elibility. 

To check your group’s 2018 QPP eligibility:

  • Log into the CMS Quality Payment Program website with your EIDM credentials
  • Browse to the Taxpayer Identification Number affiliated with your group
  • Access the details screen to view the eligibility status of every clinician based on their NPI

In response to requests from providers, CMS also now allows providers to download the list of all NPIs associated with his TIN. The file includes eligibility information for each NPI.

Questsion may be directed to the Quality Payment Program Service Center by:

  • Email: QPP [at] cms.hhs [dot] gov
  • Phone: 1-866-288-8292/TTY: 1-877-715-6222
Tags: Quality Payment, Alternative Payment Mode, MIPS


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