If you participated in the Merit-based Incentive Payment System (MIPS) in 2020, 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 2020 final score determines the payment adjustment you’ll receive in 2022, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished in 2022.

MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third party intermediary), including APM participants, 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 an error has been made in the calculation of your MIPS payment adjustment factor(s), you can request a targeted review until October 1, 2021. 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 is not a comprehensive list of circumstances. If you have questions about whether a targeted review is warranted for your circumstance, please contact the Quality Payment Program.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by:

  • Going to the Quality Payment Program website
  • Logging in using your HCQIS Access Roles and Profile System (HARP) credentials; these are the same credentials that allowed you to submit your MIPS data. Please refer to the QPP Access Guide for additional details.

For Shared Savings Program ACOs, please note that beginning August 5, 2021, you will be able to create a HARP account and manage your account 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 2020 Targeted Review User Guide (PDF). For more information on payment adjustments please refer to the 2022 MIPS Payment Year Payment Adjustment User Guide (PDF).

Questions?

Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.

Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

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