Appendix C Submission Form for Eligible Clinician and APM Entity Re
Quality Payment Program (QPP)/Merit-Based Incentive Payment System (MIPS) (CMS-10621)
Appendix C 2023 Eligible Clinician Initiated Submission Form
CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary
OMB: 0938-1314
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1314 can be found here:
Document [docx]
Download:
docx |
pdf| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced APM Determinations (Eligible Clinician I |
| Author | HHS/CMS |
| File Modified | 0000-00-00 |
| File Created | 2023-08-25 |