CMS to Grant Additional Time for MIPS Hardship Exemption

The Centers for Medicare and Medicaid Services (CMS) will give physician groups participating in the Merit-based Incentive Payment System (MIPS) additional time to apply for a waiver that will allow their data to be re-weighted to account for the impacts of COVID-19 and the surge in cases related to the Omicron variant. CMS has assured providers that individual clinicians participating in MIPS will automatically receive the exemption.

The American Medical Association applauded CMS’s decision to extend the deadline following the agency’s announcement.

The increase in COVID cases—and increased demands—coincided with the original Extreme and Uncontrollable Circumstances (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.

MIPS is one of two tracks of the Quality Payment Program established by the Medicare Access and CHIP Reauthorization Act (MACRA), the other being advanced alternative payment models. According to Inside Health Policy, MIPS is budget neutral as the bonuses used to reward high-performing providers are offset by the pay cuts to participants who fail to meet the program’s requirements. Some providers are not required by MIPS to participate.

An explainer from Business News Daily breaks down the finer elements of the MACRA-MIPS program. MIPS’ score range is calculated from zero to 100 and is comprised of quality care standards, the promotion of interoperability, patient care improvement and cost. The percentages that these are calculated on can change in the event of an exception or provider participation in an alternative payment model instead of MIPS.

Modern Healthcare notes that the CMS decision to provide the waivers might indicate how the agency intends to treat hospital quality and safety data from 2021. Data submission requirements were waived for 2020 but until now health systems have had no indication of what data reporting requirements might look like for 2021.