• How to request a review of your MIPS 2022 payment adjustment

    The Centers for Medicare & Medicaid Services (CMS) recently released final scores for 2020 Merit-based Incentive Payment System (MIPS) performance. The scores determine 2022 payment adjustments.

    Disagree with your score? You have until Oct. 1 to request that CMS check the calculation through a process called targeted review (designated support staff or an authorized third party can also request a review on your behalf). 

    Potential reasons to request a review include:

    • Data was submitted under the wrong Taxpayer Identification Number or National Provider Identifier,
    • Eligibility and special status issues (e.g., you fall below the low-volume threshold and shouldn’t receive a payment adjustment),
    • Performance categories weren’t automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances.

    This is not a comprehensive list. If you have questions about whether your circumstance merits a review, please contact the Quality Payment Program (QPP) at 1-866-288-8292 or QPP@cms.hhs.gov.

    You can request a targeted review by:

    • Going to the QPP website
    • Logging in using your HCQIS Access Roles and Profile System (HARP) credentials (the same credentials you use to submit your MIPS data). Please refer to the QPP Access Guide for additional details.

    A CMS representative will contact you with information about any specific documentation required for your review request. If CMS approves the request and changes your final score, it will update the score and your associated payment adjustment (if applicable), as soon as technically feasible. Targeted review decisions are final and not eligible for further appeal.

    For more information, check the 2020 Targeted Review User Guide (PDF) or contact the QPP at the phone number or email address above. Individuals who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant. To receive assistance more quickly, consider calling before 10 a.m.or after 2 p.m. ET.

    — Kent Moore, senior strategist for physician payment, American Academy of Family Physicians

    Posted on Aug 07, 2021 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.