Two MIPS Announcements from CMS
Targeted Review Deadline and Performance Feedback/Final Score Information Available
News | Published: Tuesday, July 3, 2018
Below are summaries of recent announcements from CMS on QPP/MIPS.
Targeted Review Deadline in 9/30/18
If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is now available for review on the Quality Payment Program website. The payment adjustment you will receive in 2019 is based on this final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.
MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including those who are subject to the APM scoring standard may request for CMS to review their performance feedback and final score through a process called targeted review.
When to Request a Targeted Review
If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until September 30, 2018. The following are examples of circumstances in which you may wish to request a targeted review:
- Errors or data quality issues on the measures and activities you submitted
- Eligibility issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)
- Being erroneously excluded from the APM participation list and not being scored under APM scoring standard
- Not being automatically reweighted even though you qualify for automatic reweighting due to the 2017 extreme and uncontrollable circumstances policy
Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted.
How to Request a Targeted Review
You can access your MIPS final score and performance feedback and request a targeted review by:
- Going to the Quality Payment Program website
- Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data. Please refer to the EIDM User Guide for additional details.
For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.
Also, CMS has posted new resources on CMS.gov to help eligible clinicians and groups understand their Merit-based Incentive Payment System (MIPS) final score, performance feedback, and payment adjustment, as well as the targeted review process. They include:
- MIPS Performance Feedback Fact Sheet: Offers an overview of what performance feedback is, who receives the feedback, and how to access it on the Quality Payment Program website.
- Targeted Review of the 2019 MIPS Payment Adjustment Fact Sheet: Details what a targeted review is and when and how to request a targeted review.
- Targeted Review of the 2019 MIPS Payment Adjustment User Guide: Provides an overview of the targeted review process, and how to access and complete the targeted review request form.
Performance Feedback and Final Score
If you submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, you can now view your performance feedback and MIPS final score.
You can access your performance feedback and final score by:
- Going to the Quality Payment Program website
- Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data
If you don’t have an EIDM account, refer to this guide and start the process now
In the coming weeks, CMS will provide additional guidance to help walk through how to review your feedback and to assist in answering your questions.
Please note: The final performance year for the Value-Based Modifier and Physician Quality Reporting System (PQRS) programs was 2016; therefore, CMS will no longer provide PQRS Feedback Reports or Quality and Resource Use Reports (QRURs). The final reports under these programs were provided in September 2017 and remain available for download through the end of this year.
MIPS Eligible Clinicians Participating in Medicare Shared Savings Program or Next Generation ACOs
If you participated in a MIPS Alternative Payment Model (APM) in 2017, specifically in a Medicare Shared Savings Program (Shared Savings Program) or Next Generation Accountable Care Organization (ACO), your performance feedback is now available to your ACO (APM Entity) via the Quality Payment Program website. Participant TINs in Shared Savings Program will be able to log into the Quality Payment Program website directly to access final performance feedback. Participants in Next Generation ACOs will need to request feedback from a representative (such as a security official) within their APM Entity.
Please note: Because all clinicians in the Next Generation ACO Model were Qualifying APM participants, performance feedback for the 2017 performance year will not be provided.
Under the MIPS APM Scoring Standard, the performance feedback, accessible to the APM Entity, will be based on the APM Entity score and is applicable to all MIPS eligible clinicians within the APM Entity group. This feedback and score does not have any impact on the Shared Savings Program or Next Generation ACOs’ quality assessment.