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CMS Re-Calculates 2017 MIPS Final Scores

Source: Emily Hill, PA, AAPM Coding Consultant

Under the Merit-Based Incentive Payment System (MIPS), CMS (Centers for Medicare and Medicaid Services) must provide practices with performance feedback based on the data reported for the prior year. The purpose of the feedback is to help practices improve care and optimize the payments received from CMS.

CMS recently released performance feedback for the 2017 reporting year. A review of this information by the American Medical Association (AMA) unveiled potential errors in the calculation. This, along with comments from physician groups, resulted in a re-calculation of the scoring logic and re-issuing of the 2017 MIPS final scores for some physicians. Physicians impacted by the following identified issues may have adjustments made to their scores:

  • Application of the 2017 Advancing Care Information (ACI) and Extreme and Uncontrollable Circumstances hardship exceptions
  • The awarding of Improvement Activity credit for successful participation in the Improvement Activities (IA) Burden Reduction Study
  • Incorrect attribution of the All-Cause Readmission (ACR) measure to certain physicians and group practices MIPS final score

MIPS also provides for a targeted review process where MIPS eligible clinicians or groups can request that CMS review the calculation of their MIPS payment adjustment factor and, as applicable, their additional MIPS payment adjustment factor for exceptional performance. Due to the scoring adjustments recently made, CMS is extending the deadline to request a targeted review until October 15, 2018.

CMS encourages all MIPS participants to submit a request if, after reviewing final performance feedback, they can provide supporting documentation that a targeted review of their MIPS payment adjustment factor (or additional MIPS payment adjustment factor) is warranted.

More information on MIPS, the performance feedback and targeted review processes can be found at: qpp.cms.gov/mips/overview.

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