Submit a MIPS Targeted Review Request by October 15

October 11, 2018
Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Practice Management, Practitioners

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS score and performance feedback are available on the Quality Payment Program website. The payment adjustment you will receive in 2019 will be based on your score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.

MIPS-eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including those who are subject to the Alternative Payment Model (APM) scoring standard, may request for the Centers for Medicare & Medicaid Services (CMS) to review their performance feedback and score through a process called targeted review if they believe an error has been made in the 2019 payment adjustment calculation. 

Please note that on September 13, 2018, CMS updated MIPS 2017 performance feedback for clinicians affected by scoring issues previously identified through the targeted review process. Additionally, to ensure that we maintain the budget neutrality required by law under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), some clinicians will see slight changes in their payment adjustment factor.

If you believe an error exists in your 2019 MIPS payment adjustment calculation, you can request a targeted review by the extended deadline of October 15 at 8:00 PM EDT, which is less than 1 week away. To learn more, view this 2017 MIPS Performance Feedback Statement.

When to Request a Targeted Review

The following are examples of circumstances in which you may wish to request a targeted review: 

  • Errors or data quality issues on 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 APM participation list and not being scored under the APM scoring standard.
  • Not being automatically reweighted even though you qualify for automatic reweighting due to the 2017 extreme and uncontrollable circumstances policy.

This is not a comprehensive list of circumstances. CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your 2019 MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.

How to Request a Targeted Review

You can access your 2017 MIPS 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, additional documentation is generally required to support the request. If your targeted review request is approved, CMS will update your score and payment adjustment factor for 2019 (if applicable) as soon as technically feasible. CMS will determine the amount of the 2019 upward 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.

For More Information

To learn more about the steps for requesting a targeted review, please review the following:

Questions?

If you have questions about your MIPS performance feedback or 2017 MIPS score, or whether you should submit a targeted review request, please contact the CMS Quality Payment Program by phone (1-866-288-8292/TTY 1-877-715-6222) or email (QPP@cms.hhs.gov).