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CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary
 
No Modified
 
Mandatory
 
42 CFR 414.1440 42 CFR 414.1335 42 CFR 414.1380 42 CFR 414.1360 42 CFR 414.1430 42 CFR 414.1400 42 CFR 414.1325 42 CFR 414.1375 42 CFR 414.1445 42 CFR 414.1395

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Appendix A Self-Nomination User Guide for Qualified Clinical Data Registries (QCDRs) and Qualified Registries Appendix A 2023MIPS QCDR and Registry Self-Nomination User Guide.docx Yes Yes Fillable Fileable
Form Appendix B1 2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) Appendix B1 2023 Payer Initiated Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix C1 2023 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) Appendix C1 2023 Eligible Clinician Initiated Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix D1 2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Appendix D1 2023 All-Payer QP Data Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix E1 Measures under Consideration 2022 (for the 2024 performance period), Data Template for Candidate Measures Appendix E1 2022 MUC Data Template.docx Yes Yes Fillable Fileable
Form and Instruction Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Appendix F1 2022 MIPS Peer-Reviewed Journal Article Requirement Template.docx Yes Yes Fillable Fileable
Form and Instruction Appendix G1 Promoting Interoperability Performance Category, 2023 Call for Measures Submission Form Appendix G1 2023 PI Call for Measures Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix H1 Improvement Activities Performance Category, 2023 Call for Activities Submission Form Appendix H1 2023 IA Call for Activities Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx Yes Yes Fillable Fileable
Form and Instruction Appendix J 2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY2023 Appendix J 2022 Extreme and Uncontrollable Circumstances Exception Application Guide.pptx Yes Yes Fillable Fileable
Form and Instruction Appendix K1 2023 MVP Candidates: Instructions and Template Appendix K1 2023 MVP Development Standardized Template v2.docx Yes Yes Fillable Fileable
Form and Instruction Appendix L1 2022 Partial QP Election Form (for submission in CY 2023) Appendix L1 Partial QP Submission Form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

159,528 0
   
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 159,528 1,285 0 -164,727 0 322,970
Annual IC Time Burden (Hours) 713,860 -3,708 0 -672,451 0 1,390,019
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk: Appendix B1 Appendix B2 2023 Payer Initiated Submission Form Crosswalk.docx 01/25/2023
Crosswalk: Appendix C1 Appendix C2 2023 Eligible Clinician Initiated Submission Form Crosswalk.docx 01/25/2023
Crosswalk: Appendix D1 Appendix D2 2023 All-Payer QP Data Submission Form Crosswalk.docx 01/25/2023
Crosswalk: Appendix E1 Appendix E2 2022 MUC Data Template Crosswalk.docx 01/25/2023
Crosswalk: Appendix F1 Appendix F2 2022 MIPS Peer-Reviewed Journal Article Requirement Template Crosswalk.docx 01/25/2023
Crosswalk: Appendix G1 Appendix G2 2023 PI Call for Measures Submission Form Crosswalk.docx 01/25/2023
Crosswalk: Appendix H1 Appendix H2 2023 IA Call for Activities Crosswalk.docx 01/25/2023
Crosswalk: Appendix K1 Appendix K2 2023 MVP Submission Template Crosswalk.pdf 01/25/2023
Crosswalk: Appendix L1 Appendix L2 2022 Partial QP Submission Form Crosswalk.docx 01/25/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.