Disqualify a Patient from MIPS Submission

All patients who are treated by a MIPS participating organization are automatically qualified for MIPS reporting. Based on measure specifications, some patient cases may be removed from the reporting population. 

As it relates to the MSK measures:

Patient cases are automatically removed from the MIPS registry if they:

• Are under the age of 18 years old 
• Are not under treatment related to one of the 5 CMS-approved measures (neck, upper extremity, back, lower extremity, or knee) as indicated by the region of injury classification
• Do not complete 2 or more patient reported outcome (PRO) for an assigned measure 
• **For the 2024 Performance Year: Have an Initial evaluation on or after 12/15/2024

Patients can be manually disqualified from MIPS if they:

• Are non-English speaking and translation services are unavailable
• Are unable to accurately complete the MIPS patient-reported outcome due to a mental or cognitive impairment
• Meet Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15
• Are determined to be extremely medical complex and likely to make poor clinical progress based on the experience and clinical judgment of the treating clinician 
• Are only seen for 1-2 visits*, and ongoing care is not indicated
• Do not have an intake and discharge visit in the same performance year (episode of care must begin and end in the performance year (ex: 1/1/2024-12/31/2024))

To disqualify a patient manually:

• Navigate to the case information 
• Edit the patient case
• Using the Reporting Qualification drop-down, select the disqualification reason