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CY 2022 Performance Period/2024 MIPS Payment Year Burden Summary
 
No Removed
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Appendix A1 (See Table 3): 2022 Qualified Registry Fact Sheet (Revised) Appendix A1 2022 MIPS Qualified Registry Self-Nomination Fact Sheet.pdf Yes No Printable Only
Other-Appendix B1 (See Table 4): 2022 Qualified Clinical Data Registry (QCDR) Fact Sheet (Revised) Appendix B1 2022 MIPS Qualified Clinical Data Registry (QCDR) Self-Nomination Fact Sheet.pdf Yes No Printable Only
Form and Instruction CMS-10621 Appendix D1 (See Table 27): 2022 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) (Revised) Appendix D1 2022 Payer Initiated Submission Form.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10621 Appendix E1 (See Table 28): 2022 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submissi Appendix E1 2022 Clinician Initiated Submission Form.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10621 Appendix F1 (See Table 29): 2022 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option (Revised) Appendix F1 2022 All-Payer QP Data Submission Form.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10621 Appendix G1 (See Table 15): Measures under Consideration 2021 (for the 2023 performance period), Data Template for Candidate Measures (Revised) Appendix G1 2021 MUC Data Template.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10621 Appendix H1 (See Table 15): 2022 Peer Reviewed Journal Article Requirement Template (Revised) Appendix H1 2022 MIPS Peer Reviewed Template .pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10621 Appendix I1 (See Table 20): Promoting Interoperability Performance Category, 2022 Call for Measures Submission Form (Revised) Appendix I1 2022 PI Call for Measures Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10621 Appendix J1 (See Table 24): Improvement Activities Performance Category, 2022 Call for Activities Submission Form (Revised) Appendix J1 2022 IA Call for Activities Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10621 Appendix M1 (See Table 25): 2022 MVP Candidates: Instructions and Template (Revised) Appendix M1 2022 MVP Development Standardized Template v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10621 Appendix O1 (See Table 26): 2020 Partial QP Election Form (for the 2022 MIPS payment year) (New) Appendix O Partial QP Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction cms-10621 Appendix C1 (Table 4): 2022 Qualified Clinical Data Registry (QCDR) Measure Submission Template (Revised, Conversion to Webform) Appendix C1 2022 Qualified Clinical Data Registry (QCDR) measure submission template v4.0.xlsx Yes Yes Fillable Fileable
Form and Instruction cms-10621 Appendix K1 (See Table 16): 2021 Hardship Exception Application Form (for the 2023 MIPS payment year) (No change) Appendix K1 2021 Promoting Interoperability Hardship Exception Application.pdf Yes Yes Fillable Fileable
Form and Instruction cms-10621 Appendix L1 (See Table 16): 2021 Extreme and Uncontrollable Circumstances Application Form for the 2023 MIPS payment year (No change) Appendix L1 2021 Extreme and Uncontrollable Circumstances Reweighting Application.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10621 Appendix N1 (See Table 13): 2021 CMS Web Interface and CAHPS for MIPS Registration Guide (for the 2023 MIPS payment year) (Revised) Appendix N1 2022 CMS Web Interface and CAHPS for MIPS Registration Guide.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

119,890 119,890
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 0 -310,051 0 310,051
Annual IC Time Burden (Hours) 0 0 0 -1,435,361 0 1,435,361
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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