CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary

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

OMB: 0938-1314

IC ID: 250664

Documents and Forms

Document Name Document Type
Form Appendix A CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction
Appendix A 2023 QCDR and Registry Self-nomination User Guide Appendix A 2023 QCDR and Registry Self-Nomination User Guide_508.pdf Form and Instruction
Appendix A 2023 QCDR and Registry Self-nomination User Guide Appendix A 2023 QCDR and Registry Self-Nomination User Guide_508.pdf Form and Instruction
Appendix B Payer Initiated Submission Form Appendix B 2022 Payer Initiated Submission Form.pdf Form
Appendix B Payer Initiated Submission Form Appendix B 2022 Payer Initiated Submission Form.pdf Form
Appendix C Eligible Clinician Initiated Submission Form Appendix C 2022 Clinician Initiated Submission Form.pdf Form
Appendix C Eligible Clinician Initiated Submission Form Appendix C 2022 Clinician Initiated Submission Form.pdf Form
Appendix D Submission Form for Requests for Qualifying Alternative Appendix D 2022 All-Payer QP Data Submission Form.pdf Form
Appendix D Submission Form for Requests for Qualifying Alternative Appendix D 2022 All-Payer QP Data Submission Form.pdf Form
Appendix E Data Template for Candidate Measures Appendix E 2021 MUC Data Template.pdf Form
Appendix E Data Template for Candidate Measures Appendix E 2021 MUC Data Template.pdf Form
Appendix F 2022 Peer Reviewed Journal Article Requirement Template Appendix F 2022 MIPS Peer Reviewed Template .pdf Form
Appendix F 2022 Peer Reviewed Journal Article Requirement Template Appendix F 2022 MIPS Peer Reviewed Template .pdf Form
Appendix G Promoting Interoperability Performance Category, 2022 Ca Appendix G 2022 PI Call for Measures Submission Form.pdf Form
Appendix G Promoting Interoperability Performance Category, 2022 Ca Appendix G 2022 PI Call for Measures Submission Form.pdf Form
Appendix H Improvement Activities Performance Category, 2022 Call f Appendix H 2022 IA Call for Activities Submission Form.pdf Form
Appendix H Improvement Activities Performance Category, 2022 Call f Appendix H 2022 IA Call for Activities Submission Form.pdf Form
Appendix I 2021 Hardship Exception Application Form Appendix I 2021 Promoting Operability Hardship Exception Application.pdf Form
Appendix I 2021 Hardship Exception Application Form Appendix I 2021 Promoting Operability Hardship Exception Application.pdf Form
Appendix J 2021 Extreme and Uncontrollable Circumstances Applicatio Appendix J 2020 Extreme and Uncontrollable Circumstances Reweighting Application.pdf Form
Appendix J 2021 Extreme and Uncontrollable Circumstances Applicatio Appendix J 2020 Extreme and Uncontrollable Circumstances Reweighting Application.pdf Form
Appendix K 2022 MVP Candidates: Instructions and Template Appendix K 2022 MVP Development Standardized Template.pdf Form and Instruction
Appendix K 2022 MVP Candidates: Instructions and Template Appendix K 2022 MVP Development Standardized Template.pdf Form and Instruction
Appendix L 2020 Partial QP Election Form Appendix L Partial QP Submission Form.pdf Form
Appendix L 2020 Partial QP Election Form Appendix L Partial QP Submission Form.pdf Form