Medicare Compliance & Reimbursement

If your MIPS data, final score, or payment adjustment for the 2021 performance year doesn’t match up with your files, now is the time to request a Targeted Review before the window closes.

Then: The Centers for Medicare & Medicaid Services (CMS) recently updated Merit-Based Incentive Payment System (MIPS)-eligible clinician accounts with 2021 performance year final scores for preview (see Medicare Compliance & Reimbursement, Vol. 48, No. 13). The preview option is new this year and is part of CMS’ efforts to offer providers more transparency about payment adjustments and MIPS final scores.

Remember: “For MIPS-eligible clinicians, your 2021 final score determines the payment adjustment you’ll receive in 2023; a positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2023,” reminds CMS in an Aug. 22 alert.

Now: CMS announced that the MIPS 2021 Targeted Review period has begun, reminding MIPS-eligible clinicians that their 2021 final scores determine their 2023 payments, the alert says. Plus, those 2023 MIPS payments reflect “a positive, negative, or neutral payment adjustment [which] will be applied to the Medicare paid amount for covered professional services furnished in 2023,” CMS explains.

CMS allows MIPS-ECs to request a Targeted Review of their data when they discover an error in payment adjustment calculations. Past reasons for requests have included MIPS eligibility and status errors; incorrect National Provider Identifier or Taxpayer Identification Number; or the reweighting of the wrong performance category, according to the agency.

MIPS-ECs, groups, virtual groups, and APM entities can request Targeted Reviews via the Quality Payment Program portal through Oct. 21.

Review MIPS 2021 data and make review requests at https://qpp.cms.gov/login.