Merit-Based Incentive Payment System (MIPS) participants completed data submissions in March 2022. Soon, program participants will be able to review performance feedback, including their MIPS final score and payment adjustment factor(s) on the Quality Payment Program (QPP) website.
Final scores will dictate the payment adjustment a participant will receive in 2023, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician.
An important part of the performance feedback review is the Targeted Review process available to eligible participants.
QPP participants can request a targeted review for the calculation of their Merit-based Incentive Payment System (MIPS) payment adjustment factor(s).
The Targeted Review request window will open in late summer and remain open for 60 days for participants questioning their MIPS final performance feedback and MIPS payment adjustment factor(s).
Telligen, as part of the QPP Customer Service Center, processes Targeted Reviews for eligible participants who request a review.
When to Request a Targeted Review
Participants can submit a request to review a lower payment adjustment than anticipated, reasons for not meeting the scoring threshold or general questions about their score.
Examples of previously Targeted Review circumstances include the following:
- Errors or data quality issues for the measures and activities submitted
- Quality performance category score denominator wasn’t lowered
- Performance categories were not automatically reweighted even though the submission qualifies for automatic reweighting due to extreme and uncontrollable circumstances
Eligible participants who can request a Targeted Review include:
- MIPS eligible clinician
- Virtual group
- Alternative Payment Model (APM) participant
At Telligen, Quality reporting program subject-matter expert, Brian Warren, oversees the Targeted Review process every year. Brian has extensive experience with quality reporting programs, including the legacy Physician Quality Reporting System (PQRS) and Electronic Prescribing Reporting (ERX) program.
“This background helps me bridge the gap between understanding policy and how that relates to the technical aspect when people are coding files to submit data,” said Warren.
Telligen’s Targeted Review team has processed more than 7,000 cases to date and uses a streamlined process to analyze the inquiries. Each targeted review is researched and analyzed individually.
“When we close an inquiry or approve a Targeted Review, we are solving a problem and helping a participant understand the program. It is very gratifying to help people,” said Warren.
Participants can access the Targeted Review application through their QPP account on qpp.cms.gov.