MIPS payment adjustments released — how to request a review 

The Centers for Medicare & Medicaid Services (CMS) has released performance year 2023 feedback and final scores for the Merit-based Incentive Payment System (MIPS). Your final score determines the positive, negative, or neutral payment adjustment you’ll receive for Medicare-covered professional services in 2025. 

There is no exceptional performance adjustment for 2025 payments, because Congressional funding for it expires after the 2024 payment year. 

To access your feedback and score, follow these steps: 

• Sign in to the Quality Payment Program (QPP) website using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) system credentials — the same credentials you used to submit your 2023 MIPS data. 

• Click “View Feedback” on the home page and select your organization: Practice, Alternative Payment Model (APM) Entity, or Virtual Group. 

Note that 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) and start the process now. 

Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) should identify at least one individual within their ACO who can obtain a HARP account with the Security Official role; additional individuals may request the Staff User role. Representatives of MSSP ACO Participant Taxpayer Identification Numbers 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. 

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).  

How to request a review of your score

If you believe CMS made an error calculating your MIPS payment adjustment factor(s), you can request a targeted review until 8 p.m. ET on Oct. 11.

Examples of situations that may merit a targeted review include: 

• Data submitted under the wrong Tax Identification Number or National Provider Identifier. 

• You have Qualifying APM Participant 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. 

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

To request a targeted review, follow these steps: 

• Sign in using your HARP credentials (ACO-Management System credentials for Shared Savings Program ACOs). 

• Click “Targeted Review” on the left-hand navigation. 

CMS generally requires documentation to support a review request. A CMS representative will contact you about providing specific required documentation. If CMS approves your targeted review request and changes your score, the agency will update your payment adjustment (if applicable), as soon as technically feasible. Please note that targeted review decisions are final and not eligible for further review. 

Resources for more information

Performance feedback resources: 

• 2023 MIPS Performance Feedback FAQs (PDF) – Reviews the information available in performance feedback and how to access it. 

• 2023 MIPS Performance Feedback Supplemental Reports Guide (PDF) – Reviews the downloadable supplemental and patient-level reports for administrative claims quality and cost measures. 

• 2025 MIPS Payment Year Payment Adjustment User Guide (PDF) – 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. 

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. 

— Kent Moore, AAFP Senior Manager, Payment Strategies

Posted on Aug. 16, 2024