びびなび : ワシントンDC : (アメリカ合衆国) Washington DC

Centers for Medicare & Medicaid Services Quality Payment Program
* Reminder: 2023 Targeted Review Available  [ #link_1 ]
* Reminder: 2024 QPP Exception Applications are Available [ #link_2 ]

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Reminder: 2023 Targeted Review Available

Review your MIPS performance feedback, including your MIPS final score and payment adjustment factor(s), on the Quality Payment Program website [ https://qpp.cms.gov/login ]. 


* Individual clinicians, groups, subgroups, virtual groups, APM Entities (including Shared Savings Program ACOs), designated support staff and authorized third party intermediaries may request that CMS review the calculation of their MIPS payment adjustment factor(s) through a process called targeted review. 

*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 [ https://qpp.cms.gov/login ] 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)* [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2961/2023-Targeted-Review-Guide.pdf ] – 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)* [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2962/2025-MIPS-Payment-Adjustment-User-Guide.pdf ] – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions. 

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Reminder: 2024 QPP Exception Applications are Available

The 2024 Quality Payment Program (QPP) Exception applications are available through *December 31, 2024, at 8 p.m. ET*. There are 2 types of exception applications that allow users to indicate the reason they’re unable to report data for one or more Merit-based Incentive Payment System (MIPS) performance categories. 

*MIPS Promoting Interoperability Performance Category Hardship Exception Application* 

Individual clinicians, groups, and virtual groups (or a third-party representative) can submit a MIPS Promoting Interoperability Performance Category Hardship Exception application for the following reasons: 


* You have decertified Electronic Health Record (EHR) technology (must be decertified under the Office of the National Coordinator for Health Information Technology’s (ONC) Health IT Certification Program). 

* You have insufficient internet connectivity. 

* You face extreme and uncontrollable circumstances such as a disaster, practice closure, severe financial distress, or vendor issues. 

* You lack control over the availability of certified EHR technology (CEHRT). 

This application is specific to the MIPS Promoting Interoperability performance category. If your application is approved, you won’t be required to report data for this performance category. 

*MIPS Extreme and Uncontrollable Circumstances Exception Application* 

Individual clinicians, groups, and virtual groups (or a third-party representative) can submit a MIPS Extreme and Uncontrollable Circumstances (EUC) Exception application for one or more MIPS performance categories (quality, cost, improvement activities, and Promoting Interoperability) due to extreme and uncontrollable circumstances, defined as rare events entirely outside of your control and the control of the facility in which you practice. 

These circumstances would: 


* Cause you to be unable to collect information necessary to submit for a MIPS performance category. 

* Cause you to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example, if you were unable to collect data for the quality performance category for 3 months). 

* Impact your normal processes, affecting your performance on cost measures and other administrative claims measures. 

Alternate Payment Model (APM) Entities can submit applications as well, but they must apply for all performance categories. 

If your application is approved, you won’t be required to report data for the performance category or categories included in your approved application. However, please note that data submission overrides approved reweighting on a category-by-category basis.  We’ll score any data you, or someone on your behalf, submits and those performance categories will contribute to your final score. 

*How to Apply* 

To submit either Exception application: 


* Sign in to the QPP website [ https://qpp.cms.gov/login ] with your Health Care Quality Information System (HCQIS) Access Roles and Profile (HARP) account. 

* Choose “Exceptions Application” from the left-hand navigation. 

* Click “Add New QPP Exception” on the right side of the screen. 

* Choose your exception type. 

*Additional Resources* 


* Quality Payment Program Access User Guide (ZIP, 3MB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2955/QPP-Access-User-Guide.zip ] – Refer to “Step 1: Register for a HARP Account” 

* Exception Applications (webpage on the QPP website) [ https://qpp.cms.gov/mips/exception-applications?py=2024 ]  

* 2024 MIPS Promoting Interoperability Hardship Exception Application Guide (PDF, 1MB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2846/2024-MIPS-PI-Hardship-Exception-Application-Guide.pdf ]  

* 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (PDF, 1MB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2845/2024-MIPS-EUC-Exception-Application-Guide.pdf ] 
QPP Footer 2023 [ https://qpp.cms.gov/resources/help-and-support ]


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