The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2023 performance year and associated MIPS payment adjustment information for the 2025 payment year.

• Your 2023 final score determines the payment adjustment you’ll receive in 2025; a positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2025.
• REMINDER: There’s no exceptional performance adjustment for the 2023 performance year/2025 payment year. Congressional funding for the additional adjustment for exceptional performance expired after the 2022 performance year/2024 payment year.

How Do I Access Feedback?

• Sign in to the Quality Payment Program (QPP) website using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) system credentials; these are the same credentials that allowed you to submit your 2023 MIPS data.
• Click “View Feedback” on the home page and select your organization (Practice, Alternative Payment Model (APM) Entity, Virtual Group).
  • Practice representatives can access individual, subgroup, and group feedback.
  • Third party representatives can’t access final feedback or payment adjustment information.

If you don’t have a HARP account or QPP role, please refer to the Register for a HARP Account (re: HARP account) and Connect to an Organization (re: QPP role) documents in the QPP Access User Guide (ZIP, 4MB) and start the process now.

Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Medicare Shared Savings Program ACOs are encouraged to identify at least one individual within your ACO who can obtain a HARP account with the Security Official role; additional individuals may request the Staff User role. ACO individuals can create and manage their HARP account and QPP access in the ACO Management System (ACO-MS).

Contact your ACO to find out how you can obtain a HARP account via ACO-MS. If you have any questions, please contact the ACO Information Center at SharedSavingsProgram@cms.hhs.gov or 1-888-734-6433 (Option 1).

• Representatives of Shared Savings Program ACO Participant Taxpayer Identification Numbers (TINs) and practices with clinicians receiving their APM Entity’s final score won’t be able to access the APM Entity’s performance feedback unless they’ve been approved as a staff user for the APM Entity.

Performance Feedback Resources:

• 2023 MIPS Performance Feedback FAQs (PDF, 3MB) – Reviews the information available in performance feedback and how to access it.
• 2023 MIPS Performance Feedback Supplemental Reports Guide (PDF, 824KB) – Reviews the downloadable supplemental and patient-level reports for administrative claims quality and cost measures.
• 2025 MIPS Payment Year Payment Adjustment User Guide (PDF, 710KB) – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions.
• 2023 Quality and Cost Benchmarks– Links to the Benchmarks page of the QPP website where users can download the 2023 quality and cost benchmarks files and supporting documentation.

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 now until October 11, 2024, at 8 p.m. ET.

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 (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:

• Sign in using your HARP credentials (ACO-MS credentials for Shared Savings Program ACOs); these are the same credentials that allowed you to submit your 2023 MIPS data.
• Click “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) – 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) – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions.

Source: CMS Quality Payment Program Newsletter August 12, 2024