Advocacy Update

Sept. 8, 2023: Medicare Payment Reform Advocacy Update


The Centers for Medicare & Medicaid Services (CMS) recently released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2022 performance year, which determine whether a physician will receive a positive, neutral or negative payment adjustment on Medicare services furnished in 2024.

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Physicians can view this information on the Quality Payment Program (QPP) website using their HCQIS Access Role and Profile (HARP) credentials. If a physician believes there was an error in the calculation of the MIPS final score, he or she should request an appeal, which CMS calls a targeted review, by Oct. 9, 2023.

Examples of previous targeted review circumstances include the following:

  • Data were submitted under the wrong Taxpayer Identification Number (TIN) or National Provider Identifier (NPI)
  • Eligibility or special status issues (e.g., a physician has Qualifying APM Participant status and should not receive a payment adjustment)
  • Performance categories were not automatically reweighted even though a physician qualified for reweighting due to extreme and uncontrollable circumstances

CMS generally requires documentation to support a targeted review request, which varies by circumstance. A CMS representative will contact physicians and practices about providing any specific documentation required. If the targeted review request is approved and results in a scoring change, CMS will update the final score and associated payment adjustment (if applicable). 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 2022 Targeted Review User Guide (PDF).

For help registering for a HARP account, access the QPP Access User Guide (ZIP). CMS has also released several resources for more information, including:   

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