MACRA QPP Center

Physicians Advocacy Institute

Frequently Asked Questions Updated for 2020

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3. Are physicians and other eligible clinicians who practice in Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs) exempt from MIPS?

  1. Those in Critical Access Hospitals (CAHs) are not exempt from MIPS reporting.

    Physicians and other eligible clinicians who bill exclusively through their FQHC, CHC, or Rural Health Clinics (RHC) are exempt from MIPS reporting, but they can choose to voluntarily report (without being subject to a payment adjustment). If they bill under the Medicare Physician Fee Schedule (the traditional Medicare fee schedule), they are subject to participation in MIPS unless they meet one of the following exemptions.
     
    The following eligible clinicians are exempt from participation in MIPS:
    • Newly-enrolled Medicare eligible clinicians who enroll in Medicare for the first time during the performance year
    • Eligible clinicians and groups that are below the low-volume threshold:
      • Who have Medicare Part B allowed charges < $90,000
        OR
      • Who provide care to 200 or fewer Medicare Part B patients
      • Provide 200 or fewer covered professional services to Part B patients
      Use the CMS NPI lookup tool to help you determine your eligibility. To use the tool, you will need to know your 10-digit national provider identification (NPI) number.
       
    • Eligible clinicians who are participating in Advanced APMs



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