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Friday Aug 31, 2018

Still time to request review of your MIPS final score

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are available now on the Quality Payment Program website(qpp.cms.gov). Based on this final score, Medicare will adjust positively, negatively, or not at all how much you are paid for covered professional services furnished under the Medicare Physician Fee Schedule in 2019. 
If you believe Medicare has made an error in your 2019 MIPS payment adjustment calculation, you (along with your designated support staff or authorized third-party intermediary) have until Oct. 1 at 8:00 PM (EDT) to request a targeted review. Here are some examples of circumstances in which you can request a targeted review:

  • Errors or data quality issues related to 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 alternative payment model (APM) participation list and not being scored under the APM scoring standard
  • Not being automatically reweighted even though you qualify because of the 2017 extreme and uncontrollable circumstances policy

The Centers for Medicare & Medicaid Services (CMS) encourages you to contact the Quality Payment Program(qpp.cms.gov) if you believe a targeted review of your MIPS payment adjustment is warranted. They’ll help you to determine if you need to submit a targeted review request. 
You can access your MIPS final score and performance feedback and request a targeted review by:

When evaluating a targeted review request, CMS will generally require additional documentation to support the request. If CMS approves your targeted review request, the agency will update your final score and associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine how much to increase the 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.
To learn more about the steps for requesting a targeted review, please review the following:

If you have questions about your MIPS performance feedback or final score, or whether you should submit a targeted review request, please contact the Quality Payment Program by:

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 02:00PM Aug 31, 2018 by Kent Moore

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