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CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary
 
No New
 
Mandatory
 
42 CFR 414.1335 42 CFR 414.1380 42 CFR 414.1445 42 CFR 414.1360 42 CFR 414.1395 42 CFR 414.1430 42 CFR 414.1400 42 CFR 414.1325 42 CFR 414.1375 42 CFR 414.1440

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Appendix A 2023 QCDR and Registry Self-nomination User Guide Appendix A 2023MIPS QCDR and Registry Self-Nomination User Guide.docx Yes Yes Fillable Fileable
Form Appendix L 2023 MVP Registration Form (New) Appendix L MVP Registration Form.xlsx Yes Yes Fillable Fileable
Form and Instruction Appendix I 2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY 2023) (previously Appendix J) Appendix I 2022 Extreme and Uncontrollable Circumstances Exception Application Guide.pptx Yes Yes Fillable Fileable
Form and Instruction Appendix B 2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) Appendix B 2023 Payer Initiated Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix C Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) Appendix C 2023 Eligible Clinician Initiated Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix D 2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Appendix D 2023 All-Payer QP Data Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix E1 Measures under Consideration 2023 Data Template for Candidate Measures Appendix E1 2023 MUC Data Template.docx Yes Yes Fillable Fileable
Form and Instruction Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Appendix F1 2023 MIPS Peer-Reviewed Journal Article Requirement Template.docx Yes Yes Fillable Fileable
Form and Instruction Appendix J 2023 MVP Candidates: Instructions and Template (previously Appendix K) Appendix J 2023 MVP Development Standardized Template v2.docx Yes Yes Fillable Fileable
Form and Instruction Appendix K 2022 Partial QP Election Form (for submission in CY 2023) (previously Appendix L) Appendix K Partial QP Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix G Improvement Activities Performance Category, 2023 Call for Activities Submission Form (previously Appendix H) Appendix G 2023 IA Call for Activities Submission Form.docx Yes Yes Fillable Fileable
Form and Instruction Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) (previously Appendix I) Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx Yes Yes Fillable Fileable

Health Health Care Services

 

184,564 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 184,564 1,284 159,528 23,752 0 0
Annual IC Time Burden (Hours) 715,450 -4,002 713,860 5,592 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk - Appendix E2: Measures under Consideration 2023 Data Template for Candidate Measures Appendix E2 2023 MUC Data Template Crosswalk.docx 08/24/2023
Crosswalk - Appendix F2: 2023 Peer Reviewed Journal Article Requirement Template Appendix F2 2023 MIPS Peer-Reviewed Journal Article Requirement Template Crosswalk.docx 08/24/2023
Track Change - Appendix E3: Measures under Consideration 2023 Data Template for Candidate Measures Appendix E3 - Track Change (2023 MUC Data Template).docx 08/24/2023
Track Change - Appendix F3: 2023 Peer Reviewed Journal Article Requirement Template Appendix F3 - Track Change (2023 MIPS Peer-Reviewed Journal Article Requirement Template).docx 08/24/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.