CMS Releases 2021 MIPS Performance Scores, Instructions on Appealing

The Centers for Medicare & Medicaid Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for performance year 2021 and associated MIPS payment adjustment information for payment year 2023. The payment adjustment is a positive, negative, or neutral payment adjustment applied to the eligible clinician (EC) or group’s Medicare paid amount for covered professional services furnished in 2021.

ECs and groups can view their MIPS performance feedback, final score, and 2023 payment adjustment on the Quality Payment Program website or by visiting cms.gov/login. Once on these websites, ECs and groups should use their HCQIS Access Roles and Profile (HARP) system credentials. ECs and groups that do not have a HARP account should refer to the “Register for a HARP Account and Connect to an Organization” documents in the QPP Access User Guide.

MIPS ECs and groups, including APM participants, may request that CMS review the calculation of their MIPS payment adjustment factor(s) through a process called targeted review. If an EC or group believes an error has been made in the calculation of their MIPS payment adjustment factor(s), they may request a targeted review until October 21, 2022. Some examples of previous targeted review circumstances include the following:

• Data was submitted under the wrong Taxpayer Identification Number (TIN) or National Provider Identifier (NPI);
• Eligibility and special status issues (e.g., the EC or group fell below the low-volume threshold and shouldn’t receive a payment adjustment);
• Performance categories weren’t automatically reweighted even though the EC or group qualified for reweighting due to extreme and uncontrollable circumstances.

ECs and groups can request a targeted review by going to the Quality Payment Program website.

CMS generally requires documentation to support a targeted review request, which varies by circumstance. Once submitted, the EC or group will be contacted by a representative with information about any specific documentation required. If the targeted review request is approved and results in a scoring change, CMS will update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. Targeted review decisions are final and not eligible for further review.

For more information about how to request a targeted review, please refer to the 2021 Targeted Review User Guide (PDF). For more information on payment adjustments please refer to the 2023 MIPS Payment Year Payment Adjustment User Guide (PDF).