Crosswalk - Payer Initiated Submission Form

Appendix D2 Payer Initiated Submission Form Crosswalk.pdf

Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

Crosswalk - Payer Initiated Submission Form

OMB: 0938-1314

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All-Payer Payer Initiated Submission Form
CY 2020 Final versus CY 2021 Proposed

Burden impact: The changes to this form reflect proposals in the CY2021 Physician Fee
Schedule (PFS) Proposed Rule for the Quality Payment Program. There are no impacts to
burden as a result of these changes.
*****
Change #1:
Location: Page 1, Line 18
Reason for Change:
Alignment with current year.
CY 2020 Final Rule text:
2019 for the 2020
CY 2021 Proposed Rule text:
2021 for the 2022
*****
Change #2:
Location: Page 1, Line 24
Reason for Change:
Alignment with current year.
CY 2020 Final Rule text:
2020 for the 2021
CY 2021 Proposed Rule text:
2021 for the 2022
*****
Change #3:
Location: Page 1, Line 29
Reason for Change:
Alignment with current year.
CY 2020 Final Rule text:
2020 for the 2021
CY 2021 Proposed Rule text:
2021 for the 2022
*****
Change #4:
Location: Page 10, Line 4
Reason for Change:
Alignment with current year.
CY 2020 Final Rule text:
For payment arrangements beginning in performance year 2020 or later, describe how
the measure has an evidence-based focus, is reliable and valid, by meeting criteria
selected above. [Text box]

CY 2021 Proposed Rule text:
Describe how the measure has an evidence-based focus, is reliable and valid, by
meeting criteria selected above. [Text box]
*****
Change #5:
Location: Page 16, Line 15
Reason for Change:
Alignment with current year.
CY 2020 Final Rule text:
For payment arrangements beginning in performance year 2020 or later, describe how
the measure has an evidence-based focus, is reliable and valid, by meeting criteria
selected above. [Text box]
CY 2021 Proposed Rule text:
Describe how the measure has an evidence-based focus, is reliable and valid, by
meeting criteria selected above. [Text box]
*****
Change #6:
Location: Page 22, Line 16
Reason for Change:
Alignment with current year.
CY 2020 Final Rule text:
For payment arrangements beginning in performance year 2020 or later, describe how
the measure has an evidence-based focus, is reliable and valid, by meeting criteria
selected above. [Text box]
CY 2021 Proposed Rule text:
Describe how the measure has an evidence-based focus, is reliable and valid, by
meeting criteria selected above. [Text box]
*****
Change #7:
Location: Page 26, Line 5
Reason for Change:
Edit to reflect current contact.
CY 2020 Final Rule text:
[email protected]
CY 2021 Proposed Rule text:
[email protected]


File Typeapplication/pdf
File TitleAll-Payer Payer Initiated Submission Form: CY 2020 Final vs CY 2021 Proposed
AuthorCMS
File Modified2020-08-03
File Created2020-08-03

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