If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and 2019 payment adjustment, as well as more detailed performance feedback, is now available for review on the Quality Payment Program (QPP) website. Note that the QPP website is the only way to access performance feedback for MIPS. CMS is no longer distributing Quality and Resource Use Reports (QRUR), as it did in the past under programs such as the Physician Quality Reporting System (PQRS) and the Value Modifier.
Who Will Receive MIPS Performance Feedback?
Individual clinicians (including voluntary submitters), groups, and MIPS Alternative Payment Model (APM) Entities (those with MIPS eligible clinicians scored under the APM scoring standard) who participated in MIPS in 2017 will receive performance feedback. Clinicians who practice in multiple groups (as identified by a Taxpayer Identification Number, or TIN) will have performance feedback for each group under which they participated in MIPS.
What’s Included in the Feedback?
2017 MIPS performance feedback reflects all the MIPS data submitted or calculated for an individual clinician, group, or APM Entity participating in MIPS, regardless of reporting mechanism (e.g., claims, Qualified Registry, Qualified Clinical Data Registry or QCDR, EHR, or Web-based attestation). The feedback also should reflect final special scoring circumstances, such as adjustments made for small practices or hospital-based clinicians). Data presented includes 2017 final MIPS scores, 2019 MIPS payment adjustments applied to MIPS eligible clinicians, and more granular MIPS performance category scores and weights.
How Are Final Scores Assigned to Clinicians?
Since a MIPS eligible clinician’s data could have been submitted to CMS for evaluation as an individual, a group practice, and/or an APM Entity, it’s possible for more than one MIPS final score to be associated with a single TIN/NPI. However, only one MIPS final score is assigned to each unique TIN/NPI combination for purposes of calculating the MIPS payment adjustment for that specific TIN/NPI.
If multiple final scores are associated with one of a MIPS eligible clinician’s TIN/NPI combinations, the following hierarchy is used to assign one final score to that TIN/NPI:
- If a MIPS eligible clinician is a participant in a MIPS APM, then the APM Entity final score is used instead of any other final score.
- If a MIPS eligible clinician received more than one APM Entity final score, then the highest APM Entity score will be used.
- If a MIPS eligible clinician reported both as an individual and through a group and is not part of an APM Entity, the higher of the two final scores will be used, which means that this individual could receive a different payment adjustment than other clinicians in his group practice in 2019.
Also keep in mind that you will receive a separate MIPS score and payment adjustment for each unique practice (i.e., unique TIN/NPI combination) that you are affiliated with in 2019.
How Do I Access My MIPS Performance Feedback?
Individual clinicians, group practices, Medicare Shared Savings Program Accountable Care Organizations (ACOs) and Next Generation ACOs that participated in MIPS, and their authorized representatives will be able to access performance feedback by logging into https://qpp.cms.gov/ using Enterprise Identity Management (EIDM) credentials. These are the same credentials that allowed clinicians to submit and view their MIPS data via CMS’ Web portal during the submission period. If you do not have an EIDM account, refer to this EIDM User Guide or EIDM ACO User Guide as appropriate, and start the process as soon as possible. Securing an EIDM account will ensure you can securely access MIPS performance feedback in a timely manner, and if necessary, submit a request for a targeted review if you believe there is an error in your final score or payment adjustment. CMS encourages clinicians and practice representatives to obtain the necessary EIDM credentials no later than July 31, 2018. Keep in mind that there are various EIDM security access roles that you or a third-party vendor (e.g. a QCDR) can request to access your feedback so it’s important to carefully read through the User Guides and other guidance materials listed below.
Note that with the exception of Shared Savings Program and Next Generation ACOs, APM Entities that participated in MIPS and were scored under the APM scoring standard will not be able to access their MIPS performance feedback by logging into https://qpp.cms.gov/ and therefore will not need to secure an EIDM account to access performance feedback (for a full list of MIPS APMs, click here). Final MIPS performance feedback will be distributed separately to APM Entities with at least one MIPS eligible clinician scored under the APM scoring standard.
What if I Believe There’s an Error with My Final Score or Performance?
MIPS eligible clinicians or groups, along with their designated support staff or authorized third-party intermediary, can request a targeted review if you believe there is an error. CMS encourages clinicians to request a targeted review at the same level (individual or group) as the data was submitted to MIPS. You also may be asked to provide supporting documentation in connection with your request. You may request a targeted review by selecting the ‘Request a Review’ link at the bottom of each page of your performance feedback. Note that CMS will only accept these requests through October 1, 2018 at 8:00pm (EDT).
Where Can I Find Additional Information?
For additional information, we encourage you to review the following CMS resources:
If you have questions about your performance feedback or MIPS final score, you may also contact the Quality Payment Program at 866-288-8292 (TTY: 877-715-6222) or QPP@cms.hhs.gov.