Eligible providers who participated in the Merit-based Incentive Payment System (MIPS) in 2017 can now review their final score and performance feedback on the Quality Payment Program website. As we reported back in June, 91 percent of eligible clinicians participated in the first year of MIPS, which exceeded the CMS goal of 90 percent participation for 2017.
Based on a provider’s participation, a final score has been assigned to each unique NPI/TIN combination the provider is associated with. The payment adjustment providers will receive in 2019 is based on this final score. As such, 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 based on the final MIPS score of each NPI/TIN combination.
If multiple final scores are associated with one of a MIPS eligible provider’s TIN/NPI combinations, the following hierarchy is used to assign one final score to that TIN/NPI:
- If a MIPS eligible clinician is a participant in a MIPS APM, then the APM Entity final score is used instead of any other final score.
- If a MIPS eligible clinician received more than one APM Entity final score, then the highest APM Entity score will be used.
- If a MIPS eligible clinician reported both as an individual and through a group and is not part of an APM Entity, the higher of the two final scores will be used.
To access MIPS final scores and performance feedback, providers should sign on to the Quality Payment Program website using with the same EIDM credentials that allowed them to submit and view their data during the submission period.
After reviewing their MIPS final score and 2019 MIPS payment adjustment calculation, providers who believe an error has been made can request a targeted review through September 30, 2018. According to the Centers for Medicare and Medicaid Services (CMS), the following examples are 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 APM scoring standard
- Not being automatically reweighted even though you qualify for automatic reweighting due to the 2017 extreme and uncontrollable circumstances policy
Targeted reviews can also be requested through the Quality Payment Program website. Most targeted review requests will require additional supporting documentation. If the targeted review request is approved, CMS will update the final score and associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine the amount of the upward payment adjustments after the conclusion of the targeted review submission period. Targeted review decisions are final and not eligible for further review.
For more information about accessing, reviewing, and interpreting your MIPS final score and performance feedback, check out the Merit-based Incentive Payment System (MIPS) 2017 Performance Feedback User Guide.
For more information about payment adjustments and how they are determined for 2017, review the CMS Fact Sheet: 2019 Merit-based Incentive Payment System (MIPS) Payment Adjustments based on 2017 MIPS Final Scores.
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