QPP Website Update: 2018 Performance Feedback for MIPS Quality Data Submitted via Claims Now Available

MIPS Eligible Clinicians Submitting Quality Data via Claims Can Now View Performance Feedback for 2018

CMS has updated the Quality Payment Program website so individual eligible clinicians who choose to submit their Quality performance category data via claims can access performance feedback for the 2018 performance year on an ongoing basis.

If you are participating in MIPS as an individual clinician and you have chosen to use claims to submit Quality performance category data, you attach quality data codes (G-codes) to your claims throughout the 2018 performance year. Those who have been doing so can now login to the Quality Payment Program website and review their performance feedback, which will be updated on a monthly basis.

Submitting Quality Performance Data via Claims

When you submit your quality data to CMS through your claims, they’ll be processed to final action by the Medicare Administrative Contractor (MAC). The last day for submitting 2018 claims with quality data codes for the 2018 performance period is determined by your MAC, but data must be submitted on claims with dates of service during the performance period and must be processed no later than 60 days after the close of the performance period. Please check with your MAC for this guidance.

As a reminder: claims-based quality measures are calculated automatically by CMS based on the quality data codes submitted on your 2018 claims. Claims data submission is only an option for Year 2 (2018) if you’re participating in MIPS as an individual (not as part of a group).

Questions?

For more information about submitting your Quality performance category data via claims, review the 2018 Claims data submission fact sheet. For questions, contact the Quality Payment Program Service Center by:

Email: QPP@cms.hhs.gov
Phone: 1-866-288-8292/TTY: 1-877-715-6222

New QPP CME Modules, Infographics, and Scoring Guide Now Available

CMS has posted three new continuing medical education (CME) modules on the Merit-based Incentive Payment System (MIPS) performance categories and MIPS Alternative Payment Models (APMs). You can access them by logging into your Medicare Learning Network account or creating one here.

The new CME modules include:

2018 Improvement Activities Performance Category CME Module: Covers the basics of the MIPS Improvement Activities performance category including reporting requirements, scoring, and flexibilities for small and rural practices.
2018 Cost Performance Category CME Module: Offers an overview of the MIPS Cost performance category and how CMS calculates Cost scores.
2018 MIPS APM CME Module: Provides an overview of MIPS APMs, the APM scoring standard, and reporting requirements for MIPS APM participants.

Additional Quality Payment Program Resources

CMS has also posted the following new resources:

2018 Quality Payment Program Participation Infographic: Explains how eligible clinicians can participate in the Quality Payment Program for the 2018 performance year.
2018 MIPS Data Submission Infographic: Reviews how MIPS eligible clinicians can submit data for the 2018 performance year.
2018 MIPS Scoring 101 Guide: Provides a detailed overview of how each MIPS performance category is scored, how CMS calculates bonus points, and how the payment adjustment is calculated based on the MIPS final score.

For More Information:

Questions?

Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292 (TTY: 1-877-715-6222).

The Deadline to Submit a MIPS Targeted Review Request is Today

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS score and performance feedback are available on the Quality Payment Program website. The payment adjustment you will receive in 2019 will be based on your score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including those who are subject to the APM scoring standard, may request for CMS to review their performance feedback and score through a process called targeted review if they believe an error has been made in the 2019 payment adjustment calculation.

Please note, on September 13, 2018, CMS updated MIPS 2017 performance feedback for clinicians affected by scoring issues previously identified through the targeted review process. Additionally, to ensure that we maintain the budget neutrality required by law under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), some clinicians will see slight changes in their payment adjustment factor. If you believe an error exists in your 2019 MIPS payment adjustment calculation, you can request a targeted review by the extended deadline of October 15 at 8:00 PM EDT- which is tonight. To learn more, view this 2017 MIPS Performance Feedback Statement.

When to Request a Targeted Review

The following are examples of circumstances in which you may wish to request a targeted review:

Errors or data quality issues on the measures and activities you submitted
Eligibility 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 APM scoring standard
Not being automatically reweighted even though you qualify for automatic reweighting due to the 2017 extreme and uncontrollable circumstances policy

This is not a comprehensive list of circumstances. CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your 2019 MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.

How to Request a Targeted Review

You can access your 2017 MIPS score and performance feedback and request a targeted review by:

Going to the Quality Payment Program website
Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data. Please refer to theEIDM User Guide for additional details.

When evaluating a targeted review request, we will generally require additional documentation to support the request. If your targeted review request is approved, CMS will update your score and payment adjustment factor for 2019 (if applicable), as soon as technically feasible. CMS will determine the amount of the 2019 upward payment adjustments after the conclusion of the targeted review submission period. Please note that targeted review decisions are final and not eligible for further review.

For More Information

To learn more about the steps for requesting a targeted review, please review the following:

Questions?

If you have questions about your MIPS performance feedback or 2017 MIPS score, or whether you should submit a targeted review request, please contact the Quality Payment Program by:

Phone: 1-866-288-8292/TTY: 1-877-715-6222; or
Email: QPP@cms.hhs.gov