If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. The MIPS payment adjustment you will receive in 2020 is based on your 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 2020.
MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request that CMS review their performance feedback and final score calculation through a process called targeted review. The deadline to submit your request is September 30, 2019 at 8:00 PM (EDT).
When to Request a Targeted Review
If you believe an error has been made in your 2020 MIPS payment adjustment factor(s) calculation, you can request a targeted review until September 30, 2019 at 8:00 PM EDT. The following are examples of circumstances in which you may wish to request a targeted review:
• Errors or data quality issues for the measures and activities you submitted
• Eligibility and special status 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 the APM scoring standard
PLEASE NOTE: The above is not a comprehensive list of circumstances.
CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.
How to Request a Targeted Review
You can access your MIPS final score and performance feedback and request a targeted review by:
• Go to the Quality Payment Program website
• Log in using your HCQIS Access Roles and Profile System (HARP) credentials; these are the same credentials that allowed you to submit your MIPS data. Please refer to the QPP Access User Guide for additional details, including if you do not have a HARP account or role.
When evaluating a targeted review request, CMS may require additional documentation to support the request. If your targeted review request is approved, CMS may update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine the amount of the upward payment adjustments after the conclusion of the targeted review submission period.
Please note that targeted review decisions are final and not eligible for further review.
For More Information
If you have questions about your performance feedback or MIPS final score, or whether you should submit a targeted review request, please contact the Quality Payment Program by:
• Phone: 1-866-288-8292/TTY: 1-877-715-6222
• Email: QPP@cms.hhs.gov
Contact us at Kentucky REC with your questions about the Quality Payment Program. Our team of experts is here to help: 859-323-3090.