Taking a Deeper Dive into MIPS - Non-Patient Facing Clinicians

How do you determine a non-patient facing eligible clinician in your practice who still has to report for the Quality Payment Program under MIPS?

CMS is conducting eligibility determinations based on claims data from Sept. 1, 2015, through August 31, 2016, and another period from Sept. 1, 2016, through August 31, 2017. Non-patient facing clinicians who have been identified in the first period will not have their status change because of data in the second period - that will just be used to identify more who may have been missed during the first determination set. This information will be updated on the CMS website: qpp.cms.gov at a later date.

Clinicians who bill 100 or fewer patient-facing encounters (claims that include E&M codes, surgical procedure codes and visit codes) will be considered non-patient facing. Groups are considered non-patient facing if more than 75 percent of those clinicians are determined non-patient facing. A group is defined as one that CMS would identify by a single tax identifier.

CMS will also use Medicare telehealth service claims in the determination. For a full list of those codes, visit: www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html

To read more, see here.

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