October 18, 2022 – If you participated in the Merit-based Incentive Payment System (MIPS) in 2021, you can now review your performance feedback, including your MIPS final score and payment adjustment factor(s), on the Quality Payment Program website.
For MIPS eligible clinicians, your 2021 final score determines the payment adjustment you’ll receive in 2023, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished in 2023.
MIPS eligible clinicians, groups, virtual groups and Alternative Payment Model (APM) Entities (along with their designated support staff or authorized third party intermediary) may request that CMS review the calculation of their MIPS payment adjustment factor(s) through a process called targeted review.
When to Request a Targeted Review
If you believe there’s an error in the calculation of your MIPS payment adjustment factor(s), this is your final week to request a targeted review. Requests must be submitted by October 21, 2022. Some examples of previous targeted review circumstances include the following:
- Data was submitted under the wrong Taxpayer Identification Number (TIN) or National Provider Identifier (NPI)
- Eligibility and special status issues (e.g., you fall below the low-volume threshold and shouldn’t receive a payment adjustment)
- Performance categories weren’t automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances
Note: This isn’t a comprehensive list of circumstances. If you have questions about whether your circumstances warrant a targeted review, please contact the Quality Payment Program by phone at 1-866-288-8292 (TRS: 711) or by email at QPP@cms.hhs.gov.
How to Request a Targeted Review
You can access your MIPS final score and performance feedback and request a targeted review:
- Sign in using your HCQIS Access Roles and Profile (HARP) system credentials; these are the same credentials that allowed you to submit your 2021 MIPS data
- Click “Targeted Review” on the left-hand navigation
Note: Shared Savings Program ACO representatives create and manage their HARP account and QPP access in the ACO Management System (ACO-MS). Contact your ACO to find out how you can obtain a HARP account via ACO-MS. If you have any questions, please contact the ACO Information Center at SharedSavingsProgram@cms.hhs.gov or 1-888-734-6433 (Option 1)
CMS generally requires documentation to support a targeted review request, which varies by circumstance. You’ll be contacted by a representative with information about any specific documentation required. If the targeted review request is approved and results in a scoring change, we’ll update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. Please note that 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 2021 Targeted Review User Guide (PDF). For more information on payment adjustments, please refer to the 2023 MIPS Payment Year Payment Adjustment User Guide (PDF). For a step-by-step demonstration of a targeted review request, please watch the 2021 Targeted Review Demonstration (Video).
