The Medicare Access and CHIP Reauthorization Act (MACRA, Public Law 114-10) established the Merit-Based Incentive Payment System (MIPS) as a program under which your performance in three performance categories drives the application of an incentive or penalty. The payment adjustment is applied to payments 1 year after the completion of the performance period. For example, audiologists’ performance in 2024 will determine the payment adjustment in 2026. CMS notifies Medicare providers of their payment adjustment in the fall prior to the application of the incentive or penalty. The payment adjustment could be as much as + or – 9 percent.
You must pursue a time-limited targeted review (appeals) process in order to overturn the incorrect application of the penalty. The process for requesting a targeted review is outlined here: 2022 Targeted Review User Guide – QPP.