On Sept. 13, 2018, the Centers for Medicare and Medicaid Services (CMS) announced that it has updated the 2017 Merit-based Incentive Program (MIPS) feedback that it had originally released in July of this year.
Based on concerns received during the ongoing targeted review period during which physicians and practices can request a review of their MIPS scores, CMS identified errors in the scoring logic and implemented solutions to address those errors.
Final scores were updated for physicians and practices who were affected by issues such as:
- The application of the 2017 Advancing Care Information (ACI) and Extreme and Uncontrollable Circumstances hardship exceptions.
- The awarding of Improvement Activity credit for successful participation in the Improvement Activities (IA) Burden Reduction Study.
- The incorrect attribution of the All-Cause Readmission (ACR) measure to the MIPS final score for certain physicians and practices.
Some clinicians will also see slight changes in their payment adjustment due to the reapplication of budget neutrality, CMS says.
The payment adjustment MIPS eligible clinicians receive in 2019 is based on their MIPS final 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.
Clinicians and practices who participated in the MIPS track of Medicare’s Quality Payment Program (QPP) in 2017 can check to see whether their score has been updated by visiting the QPP website, qpp.cms.gov.
Targeted Review Deadline Extended to Oct. 15
CMS has also announced that it has extended the targeted review deadline from Oct. 1 to Oct. 15. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until Oct. 15, 2018 at 8 p.m.
CMS shared several examples of circumstances that may warrant 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 Advanced Alternative Payment Model (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
CMS encourages clinicians and practices to request a targeted review if an error is suspected. To request a review, log in to the QPP website using the same EIDM credentials you used to submit your MIPS data.
Additional MACRA-MIPS Resources
These CMS Fact Sheets offer guidance on performance feedback and targeted reviews:
You can also visit CMS’ Quality Payment Program resource library or contact the QPP at QPP@cms.hhs.gov or 1-866-288-8292 (TTY: 1-877-715-6222).
The Pennsylvania Medical Society (PAMED) offers a wide variety of MACRA resources for our members, including a comprehensive guide to MACRA Year 2, at www.pamedsoc.org/macra.
PAMED members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.