CMS finds errors, makes corrections to MIPS payments

Medicine Money
CMS is recommending doctors review corrected MIPS payments after discovering calculation errors. (Getty/utah778)

The Centers for Medicare & Medicaid Services (CMS) has discovered it made mistakes calculating payments to some physicians in the Merit-based Incentive Payment System (MIPS).

In a notification (PDF) to providers, CMS said it discovered errors through its targeted review process, which provides the opportunity for physicians and other clinicians to request the agency review their MIPS payment adjustment factors if they suspect there is an error with their 2019 payment calculation.

“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 in the notice.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

The errors may have resulted in underpayment calculations for thousands of providers participating in MIPS, one of two payment tracks implemented under MACRA.

Correcting the errors resulted in changes to the 2017 MIPS final score that will impact 2019 payments. Revisions were made on the Quality Payment Program website on Sept. 13, CMS said, recommending clinicians sign-in to the website to review their performance feedback. Physicians and other clinicians who believe an error still exists with their payment calculation, can request a targeted review.

In light of the errors, CMS has extended the deadline to request a targeted review to Oct. 15 at 8 p.m.

CMS has said that 91% of all clinicians eligible under MIPS participated in the first year of the program, slightly exceeding the agency’s goal of 90% participation.

CMS is currently reviewing more than 15,000 comments on a proposed rule issued in July to update the Medicare physician fee schedule and outline changes for year three of the physician payment program implemented under MACRA.

CMS will issue a final rule this fall. One proposed change will allow doctors in small practices who don’t meet the existing threshold to participate in MIPS to opt in, allowing them to be eligible for bonus incentives.

Suggested Articles

Humana filed suit Friday against more than a dozen generic drugmakers alleging the companies engaged in price fixing.

Ochsner Health System is partnering with Color to launch a population health pilot program to integrate genetic information into preventive care.

Medicare Advantage open enrollment kicked off last week, and insurers are taking new approaches to marketing a slate of supplemental benefit options.