MACRA QPP Center

Physicians Advocacy Institute

Frequently Asked Questions Updated for 2020

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8. Is the low-volume threshold based on what was billed / number of patients seen in 2019, or will it be 2020?

  1. CMS conducts to eligibility determination periods:
    1. The first eligibility determination period uses the 12 months of data from October 1, 2018 – September 30, 2019 with a 60-day claims run out.
    2. CMS will run a second eligibility determination for those groups and clinicians that did not meet the low-volume threshold during the first period, and this will use data from October 1, 2019 – September 30, 2020 with a 60-day claims run out.

    Both periods apply to the 2020 reporting year. Additionally, if you are exempt based on the first eligibility determination period, CMS will not change your status based on the second eligibility determination period.



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