The deadline to appeal 2021 MIPS scores and 2023 MIPS payment adjustments is rapidly approaching. The Centers for Medicaid and Medicare Services (CMS) calls these appeals “targeted reviews”. October 21, 2022 is the last day to submit a targeted review.
In this blog, we'll review reasons you might want to submit a targeted review as well as how to do it.
What is a Targeted Review and Why Would I Submit One?
Targeted review is CMS’ term for an appeal of a MIPS score. Each year, the targeted review period is open for the 60 days after Merit-based Incentive Payment System (MIPS) scores are released, the opportunity to submit a "targeted review" closes. During this window, you can review your scores to make sure CMS has calculated your score correctly. If you believe CMS got it right, then great! Your work here is done and you can expect your payment adjustment factor in the relevant payment year to reflect your hard work.
If you find an issue with CMS' calculation of your score, you'll need to submit a targeted review. Some examples of reasons to submit for a targeted review are:
While the above reasons are all valid reasons for submission, not all reasons are considered legitimate by CMS. For example, you should not submit a targeted review for reasons like: confusion about scoring policy, not liking your payment adjustment, or disagreeing with benchmarking of measures.
How to Apply
If you are a MarsdenAdvisors client, contact your Client Success Manager to complete this process for you.
If you are not a MarsdenAdvisors client, submit using the following steps:
If you got this far in the instructions, Congratulations! You have submitted your targeted review. You should get a pop-up message confirming your submission and an email too. You'll be able to monitor the progress of your targeted review anytime on the "Targeted Review Process Summary" page. This page will allow you to track the status of your targeted review, as well as provide documentation (for up to 30 days post-submission) if necessary.
The length of time a targeted review evaluation varies significantly, so while we can't provide an estimate of when you'll know the outcome of your review, we recommend monitoring its status on the QPP page regularly. If you have questions about your request, click "View Details" and communicate with your reviewer via the comments pane.
Next Steps
If you have any questions on this, let us know!