• Is your MIPS score/Medicare payment adjustment incorrect? Time is running out to request a review

    Physicians have less than month left to submit a request for a review of their 2020 Merit-based Payment System (MIPS) payment adjustment. Physicians can submit a targeted review request if they feel their 2018 MIPS final score/2020 MIPS payment adjustments are incorrect. The Centers for Medicare & Medicaid Services (CMS) released 2018 performance feedback and 2020 payment adjustment information earlier this summer. You can access your reports through the Quality Payment Program (QPP) portal. All targeted reviews requests for the 2018 performance period/2020 payment adjustment must be submitted by Sept. 30, 2019, by 8:00 p.m. (EDT).

    CMS will only grant a targeted review for certain circumstances, such as the following:

    • 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 alternative payment model (APM) participation list and not being scored under the APM scoring standard.

    If you are unsure whether your situation qualifies for a targeted review, contact the QPP Help Desk at QPP@cms.hhs.gov or 866-288-8292.

    Targeted reviews can be requested through the QPP Portal. The QPP Access User Guide walks you through how to create a portal account if you do not have one.

    CMS may require additional documentation as it reviews your request. If your request is approved, CMS may update your final score and/or associated payment adjustment. It is important to note that targeted review decisions are final and cannot be appealed.

    You can find additional information on targeted reviews in CMS’ 2018 Targeted Review Fact Sheet and 2018 Targeted Review Frequently Asked Questions.

    — Erin Solis, Manager for Practice and Payment at the American Academy of Family Physicians

    Posted on Sep 10, 2019 by Erin Solis

    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.