CMS Extends Deadline for MIPS Targeted Review to October 1, 2018

By David White

Status Tool for 2017 Qualifying APM Participant and MIPS APMs Data Now Available

If you participate in the Merit-based Incentive Payment System (MIPS), you should have reviewed your 2017 performance feedback by now. The 2017 MIPS performance feedback, reflecting activities in performance year one of the QPP (2017), indicates if you will receive a negative, neutral, or positive payment adjustment in 2019. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018. The following are examples of circumstances in which you may 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 incorrectly excluded from the Alternative Payment Model (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


For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.

CMS has also recently released a MIPS 2017 Performance Feedback Users Guide. This document provides detailed information on accessing performance feedback and guidance on interpreting the information provided in the feedback. This resource is in addition to the previously released MIPS Performance Fact Sheet.

Quality Payment Program Participation Status Tool for 2018 Qualifying APM Participant and MIPS APMs Data

If you are a Qualifying APM Participant (QP) or MIPS APM participant, the Centers for Medicare & Medicaid Services (CMS) has updated its Quality Payment Program Participation Status Tool to include 2018. The tool has been updated based on calculations from the first snapshot of data from APM entities. The first snapshot includes data from Medicare Part B claims with dates of service between January 1 and March 31, 2018.

Later this year, CMS will release and announce the second and third QP and MIPS APM status data based on snapshots of claims between January 1 and August 31, 2018. To learn more about how CMS determines QP and MIPS APM status for each snapshot, please view the QP Methodology Fact Sheet.

What Does QP Status and MIPS APM Status Mean?

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

  • Eligible for the 5% APM incentive bonus, and 
  • Exempt from participating in MIPS


Note: If you are participating in a MIPS APM (and do not qualify as a QP or Partial QP), you will most likely need to participate in MIPS, but will be subject to the APM Scoring Standard. Check the Quality Payment Program Participation Status Tool to see if you’re eligible for MIPS in 2018.

What APMs are Included in the Quality Payment Program Participation Status Tool?

The updated Quality Payment Program Participation Status Tool includes the following 2018 Advanced APMs and MIPS APMs:

  • Comprehensive Care Joint Replacement (CJR) Payment Model (Track 1 – CEHRT)
  • Comprehensive ESRD Care (CEC) - Two-Sided Risk
  • Comprehensive Primary Care Plus (CPC+)
  • Next Generation Accountable Care Organization (ACO) Model
  • Medicare ACO Track 1+ Model
  • Medicare Shared Savings Program – Track 1
  • Medicare Shared Savings Program – Track 2
  • Medicare Shared Savings Program – Track 3


How Do I Check My QP or MIPS APM Status?

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


To check your group’s 2018 eligibility at the APM entity level: 

  • Log into the CMS Quality Payment Program website with your EIDM credentials 
  • Browse to the Taxpayer Identification Number affiliated with your group
  • Access the details screen to view the eligibility status of every clinician based on their NPI


Questions?

Contact the Quality Payment Program Service Center by:
Email: QPP@cms.hhs.gov
Phone: 1-866-288-8292/TTY: 1-877-715-6222

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Status Tool for 2017 Qualifying APM Participant and MIPS APMs Data Now Available

If you participate in the Merit-based Incentive Payment System (MIPS), you should have reviewed your 2017 performance feedback by now. The 2017 MIPS performance feedback, reflecting activities in performance year one of the QPP (2017), indicates if you will receive a negative, neutral, or positive payment adjustment in 2019. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018. The following are examples of circumstances in which you may 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 incorrectly excluded from the Alternative Payment Model (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


For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.

CMS has also recently released a MIPS 2017 Performance Feedback Users Guide. This document provides detailed information on accessing performance feedback and guidance on interpreting the information provided in the feedback. This resource is in addition to the previously released MIPS Performance Fact Sheet.

Quality Payment Program Participation Status Tool for 2018 Qualifying APM Participant and MIPS APMs Data

If you are a Qualifying APM Participant (QP) or MIPS APM participant, the Centers for Medicare & Medicaid Services (CMS) has updated its Quality Payment Program Participation Status Tool to include 2018. The tool has been updated based on calculations from the first snapshot of data from APM entities. The first snapshot includes data from Medicare Part B claims with dates of service between January 1 and March 31, 2018.

Later this year, CMS will release and announce the second and third QP and MIPS APM status data based on snapshots of claims between January 1 and August 31, 2018. To learn more about how CMS determines QP and MIPS APM status for each snapshot, please view the QP Methodology Fact Sheet.

What Does QP Status and MIPS APM Status Mean?

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

  • Eligible for the 5% APM incentive bonus, and 
  • Exempt from participating in MIPS


Note: If you are participating in a MIPS APM (and do not qualify as a QP or Partial QP), you will most likely need to participate in MIPS, but will be subject to the APM Scoring Standard. Check the Quality Payment Program Participation Status Tool to see if you’re eligible for MIPS in 2018.

What APMs are Included in the Quality Payment Program Participation Status Tool?

The updated Quality Payment Program Participation Status Tool includes the following 2018 Advanced APMs and MIPS APMs:

  • Comprehensive Care Joint Replacement (CJR) Payment Model (Track 1 – CEHRT)
  • Comprehensive ESRD Care (CEC) - Two-Sided Risk
  • Comprehensive Primary Care Plus (CPC+)
  • Next Generation Accountable Care Organization (ACO) Model
  • Medicare ACO Track 1+ Model
  • Medicare Shared Savings Program – Track 1
  • Medicare Shared Savings Program – Track 2
  • Medicare Shared Savings Program – Track 3


How Do I Check My QP or MIPS APM Status?

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


To check your group’s 2018 eligibility at the APM entity level: 

  • Log into the CMS Quality Payment Program website with your EIDM credentials 
  • Browse to the Taxpayer Identification Number affiliated with your group
  • Access the details screen to view the eligibility status of every clinician based on their NPI


Questions?

Contact the Quality Payment Program Service Center by:
Email: QPP@cms.hhs.gov
Phone: 1-866-288-8292/TTY: 1-877-715-6222

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Date:
Friday, August 24, 2018