• Asking CMS to review your MIPS-related payment adjustment for 2023

    The Centers for Medicare & Medicaid Services (CMS) recently released Merit-based Incentive Payment System final scores for the 2021 performance year. For MIPS-eligible clinicians, the 2021 final score determines the payment adjustment they’ll receive in 2023. If you believe CMS erred in calculating your score or payment adjustment, you may ask the agency to review the calculations through a process called targeted review until Oct. 21, 2022.

    Some examples of previous targeted review circumstances include:

    • Data submitted under the wrong taxpayer identification number (TIN) or national provider identifier (NPI),
    • Eligibility or special status issues (e.g., you have Qualifying Alternative Payment Model Participant status and shouldn’t receive a payment adjustment),
    • Performance categories not being automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances.

    To request a targeted review, take the follow steps:

    • Sign in using your HCQIS Access Roles and Profile (HARP) system credentials (the same credentials that allowed you to submit your 2021 MIPS data),
    • Click “Targeted Review” on the left-hand navigation.

    Note that Shared Savings Program accountable care organization (ACO) representatives create and manage their HARP account and Quality Payment Program access in the ACO Management System (ACO-MS). Contact your ACO to find out how you can obtain a HARP account via ACO-MS. If you have any questions, contact the ACO Information Center at SharedSavingsProgram@cms.hhs.gov or 1-888-734-6433 (Option 1).

    CMS generally requires documentation to support a targeted review request. A CMS representative will contact you about providing any specific documentation required. If CMS approves the targeted review request and it results in a scoring change, CMS will update your final score or associated payment adjustment (if applicable) as soon as technically feasible. Targeted review decisions are final and not eligible for further review.

    For more information about how to request a targeted review, refer to the 2021 Targeted Review User Guide (pdf). If you have questions about whether your circumstances warrant a targeted review, contact the Quality Payment Program by phone at 1-866-288-8292 (TRS: 711) or by email at QPP@cms.hhs.gov.

    — Kent Moore, Senior Strategist for Physician Payment

    Posted on August 20, 2022, by Kent Moore

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.