MIPS in 2019 for Physical Therapists: How to Participate! — Part 1



To all our Practice Perfect users: welcome to Patient360!   We are so pleased to be working with all of you under the Practice Perfect/Patient360 partnership to make MIPS reporting as easy as possible for you and your practice!


This is the first of a 3-Part Blog Series on MIPS Reporting.


So what’s the “real deal” for Physical Therapists and MIPS in 2019?  Well, the good news is, it could be up to you! There is a huge level of flexibility this year if you are not a Required Participant.  So who is a Required Participant and who gets to choose?  So glad you asked!



First of all, although PTs are new MIPS Eligible Clinician Types in 2019, MIPS reporting eligibility really comes down to Low Volume Thresholds (LVTs).


In 2019, there are a total of 3 LVTs that must be met or exceeded during the 12 month determination segments.


– Seeing >200 Part B Patients


– Billing >$90,000 in Part B Claims


– Providing >200 Part B Covered Professional Services


What this means is if your volume is under all 3 LVTs, you will essentially be given a choice, and a chance, to participate in 2019.  CMS has laid out nicely how each and every NPI can report in 2019 (see wireframe below) and for PTs these will all apply to you, so pay close attention!  Some new options exist this year!  There will be options for you as an individual, as a group, or as an opt-in, or voluntary participant.




(Source: CMS Wireframe Drawings)




A practice or NPI can Opt In to MIPS if they exceed 1 or 2 of the Low Volume Thresholds (but not all 3, as that would make them a Required MIPS participant).


There’s one small thing…, once you OPT IN officially to the program, you can’t turn around and OPT back out in 2019 if you don’t like your scores. The way around that? Use the Patient360 portal and analytics to view and monitor your scores throughout the year and make a decision on Opting In later in the reporting season (2019 submission time, which happens in early 2020).


For now, focus on loading your data to the Patient360 portal to track your scores and maximize your points, improve quality of care in real time, and then make an informed decision about whether or not to OPT IN after reviewing your progress.  This allows your practice to make the right choice for your unique circumstances.  It’s a win/win!  If, by the time fall rolls around you like your scores in the Patient360 portal and are doing well, you can OPT IN officially and hopefully get some bonus money!  On the flip side, if you notice that your scores are less than stellar, you don’t need to OPT IN, and can take the rest of the year to make improvements and be ready to shine in 2020.  The common denominator here?  Tracking your performance in order to make an informed decision about Opt In… Patient360’s analytics and tracking mechanisms allow you to see the full picture.




You can choose to Voluntarily Report if you are excluded from MIPS or are not a required participant (you do not exceed the 3 Low Volume Thresholds) in 2019.  This is available to you if you do not want to Opt In and be subject to a MIPS payment adjustment, but still want to try the program out by testing your workflows, exploring MIPS Quality Measures, and monitoring your Therapists and their performance.




If you are not required to participate (based on LVT levels), deciding not to report/participate is certainly a choice for your practice, but do keep in mind, if you anticipate being an Eligible Clinician in the future it is in your best interest to at least Voluntarily Report before penalties reach 9% in 2020.


Let’s get Started!


  1. Visit our Practice Perfect Add Ono page or the Practice Perfect Landing Page of Patient360
  2. Sign up with our helpful team
  3. Monitor your performance through the year


Patient360 will reach out to you in the fall to let you know it’s time to officially OPT IN, and how to do so, and you can decide then based on your progress if you want to or not.  It’s that simple!


Questions?  We are here to help!  email us at [email protected]


This Guest Blog is part of our ongoing partnership with Patient360 and was written by Heather Renzi, Patient360’s Business Development Manager.  It is the first in a series of Blogs surrounding MIPS for Therapists and how Practice Perfect and Patient360 have integrated to offer Practice Perfect users preferred services at a preferred rate. Stay tuned over the coming months for more, and visit the Practice Perfect Add On page or Patient360 Landing Page for more information on how to get started!

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