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Eligible clinicians and groups that participated in MIPS performance year 2017 can now view their final scores as well as review the calculation of their 2019 payment adjustment. Per the MIPS regulation, the final scores received for performance year 2017 will dictate whether an eligible clinician and/or group receive a positive, negative, or neutral payment adjustment in 2019. This payment adjustment applies to “the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.”

In addition to the availability to view 2017 final scores and feedback, physicians and practices can also request a targeted review of their scores. This review would be performed by CMS to reevaluate the calculation of the payment adjustment factor (to affect 2019) and any applicable exceptional performance adjustment factors. There are several reasons you may request a targeted review. For example:

  • You believe you were supposed to be exempt for a performance category which negatively affected your score
  • You did not receive your 5 point small practice bonus
  • Your improvement activities were miscalculated

This is not an exhaustive list of examples as there are many reasons you may feel the need to appeal your MIPS score. However, you must be prepared to submit evidence and any other relevant documentation to support your claim to the targeted review. If you fail to follow the targeted review protocol your request will be denied, and you will be barred from further appeal attempts.  This is the only way to appeal your MIPS scores for 2017! The deadline to submit a request for a targeted review is October 15, 2018.

Once ready, the requests for review can be submitted though the CMS Quality Payment Program website (qpp.cms.gov/login). To sign in, you will need your Enterprise Identity management (EIDM) credentials. If you don’t have an EIDM account set up already, we advise you to get started now; the process can be tedious!

Feel you may need a targeted review of your MIPS final scores? Reach out to a consultant at Eagle for advice or assistance with the process!

About Alex Dighero



 

Alex is a consultant and account manager for MIPS-related matters, including pathology sales support, MIPS services sales, and delivery of MIPS services. She is a certified compliance technician with the American Association of Healthcare Administrative Management. She has an MBA in health care administration from Cleveland State University.

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