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Quality Payment Program (QPP) Support Center

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Interested in Requesting a MIPS Targeted Review?

7/3/2019

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website.
The MIPS payment adjustment you will receive in 2020 is based on your final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2020.

MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request CMS to review the calculation of their 2020 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 your 2020 MIPS payment adjustment factor(s) calculation, you can request a targeted review until September 30, 2019. The following are examples of circumstances in which you may wish to request a targeted review: 
  • Errors or data quality issues for the measures and activities you submitted
  • Eligibility and special status 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 the APM scoring standard
  • Performance categories were not automatically reweighted even though you qualify for automatic reweighting due to extreme and uncontrollable circumstances
Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS payment adjustment factor (or additional MIPS payment adjustment factor, if applicable) is warranted.

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.
When evaluating a targeted review request, we may require documentation to support the request. If your targeted review request is approved, CMS may 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 2018 Targeted Review Fact Sheet and the 2018 Targeted Review FAQs.

Questions?
If you have questions about your performance feedback or MIPS final score, please contact the Quality Payment Program by: