Providers may submit 2023 MIPS exception applications to CMS

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The Centers for Medicare and Medicaid Services is accepting 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception and MIPS Promoting Interoperability Performance Category Hardship Exception Applications.

The applications for the 2023 performance year may be submitted until 8 p.m. ET on January 2, 2024.

WHY THIS MATTERS

CMS said it understands that there may be circumstances which are out of a provider's control that make it difficult to meet program requirements. 

To reduce this burden, the agency is giving providers the opportunity to apply for exceptions to meeting MIPS program requirements. In certain circumstances, these exceptions may be applied automatically. 

Exception guidelines may change each performance year due to policy changes, CMS said. 

There are two exception applications available to clinicians.

The first, the MIPS Extreme and Uncontrollable Circumstances (EUC) Exception allows providers to request reweighting for any or all performance categories if there is an extreme and uncontrollable circumstance or public health emergency, such as COVID-19, that's outside of a provider's control.

MIPS eligible clinicians, groups, and virtual groups may apply to reweight any or all MIPS performance categories if they've been affected by extreme and uncontrollable circumstances. Small practices qualify for automatic reweighting.

These circumstances must:

• cause providers to be unable to collect information necessary to submit for a MIPS performance category.
• cause providers to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example, being unable to collect data for the quality performance category for three months).
• and/or impact the normal process, affecting performance on cost measures and other administrative claims measures.

The second circumstance is the MIPS Promoting Interoperability Performance Category Hardship Exception application, which allows providers to request reweighting specifically for the Promoting Interoperability performance category.

Alternative Payment Model (APM) Entities participating in MIPS APMs can also submit an exception application. However, the policy for APM Entities differs from the MIPS EUC policy for individuals, groups and virtual groups in that: APM Entities are required to request reweighting for all performance categories; at least 75% of an APM Entity's MIPS eligible clinicians must qualify for reweighting in the Promoting Interoperability performance category; and data submission for an APM Entity won't override performance category reweighting.

The 2023 MIPS Extreme and Uncontrollable Circumstances Application Guide has information on applying to reweight the Promoting Interoperability performance category to 0% for: having decertified electronic health record (EHR) technology; having insufficient internet connectivity; extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress or vendor issues; or having lack of control over the availability of certified EHR technology (CEHRT). Simply lacking the required CEHRT doesn't qualify for reweighting, CMS said.

THE LARGER TREND

In March 2022, The Centers for Medicare and Medicaid Services allowed more time for doctors participating in the Merit-Based Incentive Payment System to use an excessive and uncontrollable circumstance (EUC) waiver order that limited the negative impact of high-quality information to their funds.

In 2020, due to COVID-19, CMS implemented extreme and uncontrollable circumstances policy exceptions and extensions for measure-reporting and data-submission deadlines for programs such as MIPS, the Medicare Shared Savings Program Accountable Care Organizations, the Hospital Inpatient and Outpatient Quality Reporting Programs, the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program and the Skilled Nursing Facility Quality Reporting Program.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org