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Centers for Medicare & Medicaid Services Quality Payment Program
* Last Day to Request a 2023 Targeted Review [ #link_1 ]
* Reminder: 2023 Performance Year Change Healthcare Cyberattack Reweighting Requests Will Be Accepted Until 8 p.m. ET Today [ #link_2 ]

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Last Day to Request a 2023 Targeted Review


Review your MIPS performance feedback, including your MIPS final score and payment adjustment factor(s), on the Quality Payment Program website [ https://qpp.cms.gov/login ]. 


* Individual clinicians, groups, subgroups, virtual groups, Alternative Payment Model (APM) Entities (including Shared Savings Program Accountable Care Organizations (ACOs)), designated support staff and authorized third party intermediaries may request that CMS review the calculation of their MIPS payment adjustment factor(s) through a process called targeted review. 

*When to Request a Targeted Review*  

If you believe there’s an error in the calculation of your MIPS payment adjustment factor(s), you can request a targeted review *until 8 p.m. ET today, October 11, 2024*.  

For example:  


* Data were submitted under the wrong TIN or National Provider Identifier (NPI).   

* You have Qualifying APM Participant (QP) status and shouldn’t receive a MIPS payment adjustment.   

* Performance categories weren’t automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances.   

*Note: *This isn’t a comprehensive list of circumstances. If you have questions about whether your circumstances warrant a targeted review, please contact the QPP Service Center by phone at 1-866-288-8292 (Telecommunications Relay Services (TRS): 711) or by email at QPP@cms.hhs.gov.    

*How to Request a Targeted Review*  

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


* Signing in [ https://qpp.cms.gov/login ] using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) credentials (ACO-MS credentials for Shared Savings Program ACOs); these are the same credentials that allowed you to submit your 2023 MIPS data.   

* Clicking “Targeted Review” on the left-hand navigation.

CMS generally requires documentation to support a targeted review request, which varies by circumstance. A CMS representative will contact you about providing any specific documentation required. If the targeted review request is approved and results in a scoring change, we’ll update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. *Please note that targeted review decisions are final and not eligible for further review.*  

*Targeted Review Resources:*  


* *2023 Targeted Review User Guide (PDF, 15MB)* [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2961/2023-Targeted-Review-Guide.pdf ] – Reviews the process for requesting a targeted review and examples for when you would or wouldn’t request a targeted review.  

* *2025 MIPS Payment Year Payment Adjustment User Guide (PDF, 710KB)* [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2962/2025-MIPS-Payment-Adjustment-User-Guide.pdf ] – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions. 

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Reminder: 2023 Performance Year Change Healthcare Cyberattack Reweighting Requests Will Be Accepted Until 8 p.m. ET Today

We recognize that some clinicians and groups affected by the Change Healthcare cyberattack may not have been able to submit a Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Exception Application for the 2023 performance year before the April 15, 2024, deadline. As a result, we’re allowing clinicians, groups, subgroups, virtual groups, and Alternative Payment Model (APM) Entities to submit a request for reweighting of one or more MIPS performance categories under our EUC exception policies at 42 CFR 414.1380(c)(2) [ https://www.ecfr.gov/current/title-42/part-414/subpart-O#p-414.1380(c)(2) ] and 42 CFR 414.1317(b)(4) [ https://www.ecfr.gov/current/title-42/part-414/subpart-O#p-414.1317(b)(4) ] solely on the basis of the Change Healthcare cyberattack, for the 2023 performance year *until 8 p.m. ET today, October 11, 2024*. 

Any clinician, group, subgroup, virtual group, or APM Entity that wasn’t able to submit their MIPS data *solely* because of the Change Healthcare cyberattack can request reweighting.  

*IMPORTANT: Because CMS reopened the window for requesting reweighting of one or more MIPS performance categories for the 2023 performance year in response to the Change Healthcare cyberattack, CMS will only approve applications citing this cyberattack as the basis for requesting reweighting under the MIPS EUC Exception policies. Any applications submitted for reasons outside of the Change Healthcare cyberattack will be denied. * 

How Can I Request 2023 Performance Year Performance Category Reweighting? 

Due to technical limitations, we’re unable to reopen the 2023 performance year MIPS EUC Exception Application form in our system, while the 2024 performance year MIPS EUC Exception Application is open. Because of these technical limitations, we’re allowing 2023 performance year reweighting requests under our EUC Exception policies to be submitted *through the MIPS Targeted Review* *form* until today, October 11, 2024, at 8 p.m. ET. You can access this form by signing in to the QPP website [ https://qpp.cms.gov/ ].  

The MIPS EUC Exception Application form currently accessible when you sign in to the QPP website [ https://qpp.cms.gov/ ] is for 2024 performance year applications only.* Don’t use the Exception Application form to request reweighting for the 2023 performance year.* 

Please review 2023 MIPS EUC Reweighting Requests Guide (PDF, 660KB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3023/PY2023%20MIPS%20EUC%20Reweighting%20Requests%20for%20Change%20Healthcare%20Cyberattack_Extension%20Guide.pdf ] for step-by-step instructions with screenshots. 

What If We Already Submitted Data? 

In accordance with our MIPS reweighting policies for individual clinicians, groups, subgroups, and virtual groups, we won’t reweight any performance category for which we’ve received data. If we received data for a MIPS performance category, we’ll calculate a score for that performance category. (Refer to 42 CFR 414.1380(c)(2) [ https://www.ecfr.gov/current/title-42/part-414/subpart-O#p-414.1380(c)(2) ].) 

If a MIPS eligible clinician is scored on 2 or more performance categories, we'll calculate a MIPS final score in accordance with our weighting policies. If a MIPS eligible clinician is scored on fewer than 2 performance categories, then they'll receive a final score equal to the performance threshold. 

In accordance with our EUC policies for APM Entities, data submission for an APM Entity won’t override performance category reweighting for all 4 MIPS performance categories. (Refer to 42 CFR 414.1317(b)(4) [ https://www.ecfr.gov/current/title-42/part-414/subpart-O#p-414.1317(b)(4) ].) If we receive an EUC Exception application for an APM Entity for the 2023 performance year and we reweight all 4 MIPS performance categories, the MIPS eligible clinicians in the APM Entity will receive a 2023 MIPS final score equal to the performance threshold and a neutral MIPS payment adjustment in the 2025 MIPS payment year.

QPP Footer 2023 [ https://qpp.cms.gov/resources/help-and-support ]


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