Medicare Compliance & Reimbursement

Mistakes happen. So, if you think there’s a problem with your Merit-Based Incentive Payment System (MIPS) performance year 2022/payment year 2024 files, now is the time to ask for a Targeted Review.

Context: The Centers for Medicare & Medicaid Services (CMS) recently updated MIPS-eligible clinician accounts with the 2022 final scores, allowing providers the opportunity to preview their submissions and results (see Medicare Compliance & Reimbursement, Vol. 49, No. 13).

Update: On Aug. 10, CMS announced that the MIPS 2022 Targeted Review period has begun, reminding MIPS-eligible clinicians that their 2022 performance year final scores determine their 2024 payments, a CMS alert says. Plus, those MIPS results reflect “a positive, negative, or neutral payment adjustment [which] will be applied to the Medicare paid amount for covered professional services furnished in 2024,” 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 using their HCQIS Access Roles and Profile (HARP) system credentials through Oct. 9. Sign in at https://qpp.cms.gov/login and navigate to the “Targeted Review” option.

Important: If you plan on requesting a Targeted Review, know that documentation is usually required and will depend on the circumstances of the review. You should expect a CMS representative to contact you about the documentation, so ensure your contact information is up to date.

“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,” CMS says. “Targeted Review decisions are final and not eligible for further review.”