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CMS admits errors in MIPS payment calculations after 'targeted review' of payment factors

In addition to those whose scores were directly impacted, some clinicians will see small changes in their payment adjustment after budgeting.

Beth Jones Sanborn, Managing Editor


CMS has announced the agency made mistakes related an undisclosed number of providers when processing their quality scores in the first year of participation for the merit-based incentive payment system, or MIPS.


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The errors made means that those providers were paid incorrectly under the MIPS program. Fixing the mistakes meant changes to the 2017 MIPS final score and associated 2019 MIPS payment adjustment for the clinicians impacted by the issues. Also, some clinicians will see small changes in their payment adjustment as a result of the reapplication of budget neutrality.


CMS said they saw 91 percent participation for the first performance year of MIPS. Thanks to requests for a targeted review of their MIPS payment adjustment factors, the agency more closely examined some reported concerns including: the application of the 2017 advancing care information and extreme and uncontrollable circumstances hardship exceptions, the awarding of improvement activity credit for successful participation in the Improvement activities burden reduction study, and the addition of the all-cause readmission measure to the MIPS final score. 

While MACRA in general saw widespread bipartisan support, there has been intense feedback on the administrative burden it places on physicians and other clinical staff. The law continues to evolve, as the American Medical Association and other national medical and physician groups have urged CMS to shorten the 2018 merit-based incentive payment system or MIPS quality measure reporting period from a full calendar year to 90 days, because of delays that would make reporting harder for physicians. The AMA and other organizations also argue that clinicians and their practices could save on labor and costs by shortening the reporting period, as well as lessening the amount of paperwork weighing physicians down and keeping them from spending more time with patients.


"Based on these requests, we reviewed the concerns, identified a few errors in the scoring logic, and implemented solutions. The targeted review process worked exactly as intended, as the incoming requests quickly alerted us to these issues and allowed us to take immediate action," CMS said.

Twitter: @BethJSanborn
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