CMS Holds Physicians Harmless from MIPS Penalties Amid COVID-19 Public Health Emergency

Last week, CMS announced it will hold physicians harmless from up to 9% MIPS penalties due to the significant disruptions of the COVID-19 public health emergency on physician practices’ performance in 2020. The Society advocated for this automatic relief from MIPS penalties and applauds CMS for ensuring PALTC clinicians will not be unduly penalized during the pandemic.

The Extreme and Uncontrollable Circumstances Hardship Exception policy will be automatically applied to ALL MIPS-eligible clinicians who do not submit any MIPS data for the 2020 performance period and avoid a 2022 payment penalty. CMS is also reopening the hardship exception application for group practices, virtual groups, and alternative payment model entities who missed the previous 2020 deadline. The re-opened application deadline is March 31, 2021. Note, groups and eligible clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus from the exceptional performance bonus pool or potentially be subject to a penalty.

Below is the official announcement from CMS:

CMS continues to offer flexibilities to provide relief to clinicians responding to the 2019 Coronavirus (COVID-19) pandemic. CMS is applying the MIPS automatic extreme and uncontrollable circumstances (EUC) policy to all MIPS eligible clinicians for the 2020 performance period. CMS is also reopening the MIPS EUC application for individual MIPS eligible clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31, 2021 at 8:00 PM ET. Please note that applications received between now and March 31, 2021, won’t override previously submitted data for individuals, groups, and virtual groups.

This listserv will review what these flexibilities mean for:

• Individual clinicians, groups, and virtual groups that haven’t submitted data
• Individual clinicians, groups, and virtual groups that have submitted data
• APM entities

For individual clinicians, groups, and virtual groups that haven’t submitted data:

• Individual MIPS eligible clinicians: You don’t need to take any additional action to qualify for the automatic EUC policy. You will be automatically identified and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) you submit data as an individual in 2 or more performance categories, or 2) your practice reports as a group, by submitting data for one or more performance category.
• Groups: You don’t need to take any further action if you’re not able to submit data for the 2020 performance period. Group participation is optional, and your individual MIPS-eligible clinicians qualify for the automatic EUC policy. They will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) they submit data in 2 or more performance categories as individuals, or 2) the practice reports as a group, by submitting data for one or more performance category.
• Virtual Groups: If you’re unable to submit data for the 2020 performance period, you must submit an EUC application for all 4 performance categories by the deadline.

For individual clinicians, groups, and virtual groups that have submitted data:

• Individual MIPS-eligible clinicians that have submitted data for a single performance category (such as Medicare Part B Claims measures submitted throughout the 2020 performance period):
  • You don’t need to take any additional action to be eligible for the automatic EUC policy.
  • You’ll be automatically identified and have all 4 performance categories reweighted to 0% and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) you submit data for another performance category, or 2) your group submits data for one or more performance category.
• Individual MIPS eligible clinicians that have submitted data as an individual for 2 or 3 performance categories:
  • You’ll receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year based on the data you’ve submitted.
  • You’ll only be scored in the performance categories for which data are submitted.
  • You can’t submit an application to override previously submitted data.

• Groups and virtual groups that have submitted data for a single performance category:
  • If you’re not able to complete data submission for other performance categories, you can submit an application to request reweighting in all 4 performance categories.
  • This includes small practices that were automatically scored as a group on Medicare Part B Claims measures submitted throughout the 2020 performance period.
  • If you don’t submit an application, your group will be scored in all performance categories unless you are eligible for reweighting in one or more performance categories.
  • If your application is approved and data isn’t submitted for another performance category, your MIPS eligible clinicians will receive a neutral payment adjustment for the 2022 MIPS payment year.

• Groups and virtual groups that have submitted data for 2 or 3 performance categories:
  • Your MIPS-eligible clinicians will receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year.
  • Your group will be scored in all performance categories unless you qualify for reweighting in one or more performance categories.
  • You can’t submit an application to override previously submitted data.

APM Entities

APM Entities participating in MIPS APMs can submit an EUC application with some differences from the MIPS EUC policy for individuals, groups, and virtual groups:

• APM Entities are required to request reweighting for all performance categories.
• More than 75% of the MIPS-eligible clinicians in the APM Entity must be eligible for reweighting in the Promoting Interoperability performance category.
• Unlike applications for individuals, groups, and virtual groups, an APM Entity’s approved application for performance category weighting will override previously submitted data.

Please note that if an APM Entity doesn’t report for the 2020 performance period (or doesn’t have an approved EUC application), their MIPS-eligible clinicians will receive a negative payment adjustment in the 2022 payment year.

Additional Resources

• 2020 MIPS Extreme and Uncontrollable Circumstances Application Resources
• Quality Payment Program COVID-19 Response fact sheet

For more information, please see the Quality Payment Program COVID-19 Response webpages of the QPP website. You can contact the Quality Payment program at 1-866-288-8292 (TRS: 711), Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.