CMS has released MIPS 2018 Performance Feedback and Final Score reports. Merit-based Incentive Payment System (MIPS) participants, who submitted 2018 data for their practices, can now view the performance feedback and MIPS final score. The score includes an eligible clinician or group’s performance category scores, final MIPS score, and payment adjustment information.
2018 MIPS Eligible Clinicians Participating in Alternative Payment Model (APM)
Performance feedback is available for 2018 MIPS participants who participated in one of the models:
- Medicare Shared Savings Program Accountable Care Organization (ACO)
- Next Generation ACO
- Comprehensive Primary Care Plus
- Oncology Care Model
- Comprehensive ESRD Care
For MIPS APM Scoring Standard, performance feedback will be based on the APM Entity score and is applicable to all MIPS eligible clinicians within the APM Entity. This feedback and score do not have any impact on assessments performed by the specific model. Individual clinicians and representatives of the APM Entity will be able to access performance feedback directly on the Quality Payment Program website using their HARP account.
How to Access 2018 MIPS Performance Feedback
Login to Quality Payment Program website using HCQIS Access Roles and Profile (HARP) system credentials which are same as used to submit the data in the year 2018.
CMS has created new “Clinician Role” allowing individual clinicians to access MIPS performance feedback for their practices, virtual groups, and APM entities.
To set up a HARP account, access the QPP Access User Guide( QPP Access User Guide).
2018 MIPS Performance Categories Weight
Meeting the reweighting criteria can affect the final weights for example non-patient facing MIPS clinicians, hardship application, extreme and uncontrollable circumstances, etc.
The final performance score range will be between 0 to 100 points.
MIPS final score may also include additional awarded bonus points.
The upward, downward or neutral payment adjustment will apply to the clinician or group’s 2020 Medicare Part B payments for covered professional services.
Request a Targeted Review
A targeted review is a process in which MIPS eligible clinicians, groups, virtual groups, and APM participants (individual clinicians, groups, and the APM Entity) can request CMS to review the calculation of their 2020 MIPS payment adjustment factor(s).
Examples of circumstances in which MIPS participants may wish to request a targeted review:
-Errors or data quality issues
-Eligibility and special status issues (Not applicable for payment adjustment as following below low-volume threshold)
-Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard
-Performance categories not automatically reweighted even though qualifying for automatic reweighting due to extreme and uncontrollable circumstances.
MIPS eligible clinicians, groups, virtual groups, and APM participants can request a targeted review after reviewing their MIPS final performance feedback in July 2019. Targeted review requests will be submitted using the targeted review request form, which can be accessed from your performance feedback page.
If you feel that an error has been made in calculating your MIPS final score or Payment Adjustments, you can request a targeted review until September 30, 2019. The confirmation email will be sent to the person who submitted the request (entered their contact information in the submitter section)
CMS may require Supporting Documentation which may include:
- Supporting extracts from the MIPS eligible clinician’s EHR
- Copies of performance data provided to a third-party intermediary by the clinician or group
- Copies of performance data submitted to CMS• QPP Service Center case numbers
- Signed contracts or agreements between a clinician/group and a third-party intermediary
- Proof of APM participation
- Partial Qualifying APM Participant (QP) election forms
Targeted review outcomes will be sent via email to the person who requested the targeted review.
If a targeted review request is denied, there will be no change to the MIPS final score or associated payment adjustment.
On approval of targeted review request, CMS may update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible.
The targeted review decisions are final and not eligible for further review. For more information about how to request a targeted review, please refer to the 2018 Targeted Review Fact Sheet and the 2018 Targeted Review FAQs.
CMS has released a video ‘How to Request a Targeted Review’
For any questions, please contact the Quality Payment Program by:
· Phone: 1-866-288-8292/TTY: 1-877-715-6222 or
· Email: QPP@cms.hhs.gov
For any help from PrognoCIS please contact :
- Phone: 1-800-552-3301 / 1-408-873-3032
· Email: QPPSupport@bizmaticsinc.com