• 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. 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 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:

    • Going to the Quality Payment Program website
    • Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data. Please refer to the EIDM User Guide for additional details.

    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 on Aug 31, 2018 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.