In light of the Coronavirus (COVID-19) pandemic, the Centers for Medicare and Medicaid Services (CMS) has been implementing different flexibilities for the Quality Payment Program (QPP). Recently, CMS announced that the agency will apply its Merit-based Incentive Payment System (MIPS) automatic extreme and uncontrollable circumstances (EUC) policy to all individual MIPS eligible clinicians. CMS also announced the re-opening of its EUC exception application for groups, virtual groups, and Alternative Payment Model (APM) entities.
Automatic Extreme and Uncontrollable Circumstances Policy
CMS will apply the MIPS automatic EUC policy to all individual MIPS eligible clinicians for the 2021 performance year. Importantly, this policy does not apply to clinicians participating in MIPS as a group, virtual group, or APM entity. However, groups, virtual groups, and APM Entities are allowed to submit an application requesting MIPS performance category reweighting, as outlined below.
This means that MIPS eligible clinicians who report as an individual will only be scored on performance categories for which data are submitted/available for scoring. All other performance categories will be reweighted to 0% of their final score. Also, under the automatic EUC policy, the cost performance category will be weighted at 0% even if data are submitted for other performance categories.
MIPS eligible clinicians reporting as individuals who submit 2021 MIPS data for 1 performance category by the March 31, 2022 deadline will automatically receive a neutral payment adjustment, unless they have a higher score from group or APM Entity participation.
MIPS eligible clinicians reporting as individuals who are scored on 2 or 3 MIPS performance categories by the March 31, 2022 deadline will receive a final score based on the performance categories for which data is submitted and may earn a negative, neutral or positive payment adjustment. (These MIPS eligible clinicians will receive the highest final score that can be attributed to them from individual, group or APM Entity participation.)
Additionally, if MIPS eligible clinicians do not submit 2021 MIPS data by March 31, 2022, they will have all performance categories reweighted to 0% and automatically receive a neutral payment adjustment (unless they have a higher score from group or APM Entity participation).
Reopening of the Uncontrollable Circumstances Application
As mentioned above, CMS also announced that the 2021 MIPS EUC application will be re-opened, to allow groups, virtual groups, and APM Entities an opportunity to submit an application requesting MIPS performance category reweighting due to the ongoing COVID-19 pandemic.
MIPS EUC applications that cite COVID-19 as the triggering event can be submitted through Thursday, March 31, 2022, at 8:00 PM ET.
Reaction
The American Medical Association (AMA), applauded the decision, releasing a statement saying, “The American Medical Association is grateful the Centers for Medicare & Medicaid Services agreed that physicians and administrative staff needed flexibility this year when filing a 2021 MIPS Extreme and Uncontrollable Circumstances (E&C) hardship application because of the Omicron surge. The increase in COVID cases – and increased demands — coincided with the original E&C hardship application deadline at the end of 2021. As a result, physicians might have missed the opportunity to file for a hardship application and faced a payment adjustment. The re-opening of the 2021 application period will give physicians, including APM participants, much-needed relief and better ensure they avoid a negative 2023 MIPS payment adjustment. As a reminder, physicians who do not submit any MIPS data for the 2021 MIPS program will automatically avoid a 2023 penalty. If a physician, practice or physician/practice part of an APM is unsure of their status, we encourage you to submit an application to avoid a penalty.”