New QPP Resource: 2019 APM Incentive Payment Fact Sheet Available

Alternative Payment Model (APM) 2019 Incentive Payment Fact Sheet Provides Information on 5% APM Incentive Payment for 2017 Performance

Starting in September, clinicians who were Qualifying Alternative Payment Model Participants (QPs) based on their 2017 performance will begin receiving their 2019 5% APM Incentive Payments.

CMS has posted a new 2019 APM Incentive Payment Fact Sheet to explain:

Who is eligible to receive an APM incentive payment in 2019
How CMS determines your 2019 Incentive Payment
Answers to frequently asked questions

Reminder: What Does Qualifying Alternative Payment Model Participant (QP) Status Mean?

If you qualify as a QP, this means you are:

Eligible for the 5% APM incentive payment for the applicable payment year; and
Excluded from MIPS reporting requirements and payment adjustments.

How Do You Check Your QP or APM Participation Status?

To view your QP or APM participation status at the individual level:

Go to: https://qpp.cms.gov/participation-lookup
Enter your 10-digit National Provider Identifier (NPI)

Learn More

Later this fall you will be able to verify your information by going to the QPP portal where you will see the incentive payment amount and the billing NPI for both for the NPI and for the organization. For more information on APMs and lists of current APM participants, visit the QPP APM webpages. You can also contact the Quality Payment Program at 1-866-288-8292 (TTY 1-877-715-6222), Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

The Deadline to Submit a MIPS Targeted Review Request is Monday

You Have 3 Days to Submit a Targeted Review Request

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 under the Medicare Physician Fee Schedule in 2020.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request for CMS to review their performance feedback and final score calculation through a process called targeted review. The deadline to submit your request is Monday, September 30, 2019 at 8:00 PM (EDT) – which is just 3 days away.

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 at 8:00 PM (EDT). 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

Note: 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 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 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 User Guide for additional details, including if you do not have a HARP account or role.

When evaluating a targeted review request, we may require additional 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. CMS will determine the amount of the 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 performance feedback or MIPS final 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