Automatic MIPS Participation Exemption for Individual Eligible Clinicians

CMS is exempting all individual eligible clinicians from Merit-Based Incentive Payment System (MIPS) participation in the 2021 performance year (PY). The eligible clinicians will receive an automatic neutral payment adjustment for the 2023 MIPS payment year, the agency recently announced via email.

The email sent to the CMS Quality Payment Program listserv said CMS is applying the automatic extreme and uncontrollable circumstances (EUC) policy because of the ongoing COVID-19 pandemic. CMS also applied the EUC policy last year to individually eligible clinicians participating in MIPS during PY 2020. The clinicians will also receive a neutral payment adjustment in the 2022 MIPS payment year.

“The Centers for Medicare & Medicaid Services (CMS) continues to provide relief where possible to clinicians responding to the 2019 Coronavirus (COVID-19) public health emergency (PHE),” the email stated.

The automatic exemption notably does not apply to eligible clinicians participating in groups, virtual groups, or as an Alternative Payment Model (APM) entity, according to the email.

The EUC exemption also does not apply to accountable care organizations (ACOs) in the Medicare Shared Savings Program. Although, ACOs can submit an application for MIPS participation exemption on behalf of their eligible clinicians as long as more than three-quarters of its MIPS eligible clinicians would be eligible for reweighting of the Promoting Interoperability performance category.

CMS noted that group and APM participation is optional and individually eligible MIPS eligible clinicians will qualify for the automatic exemption if they do not report data at the group level.

For virtual groups, CMS will adjust payments based on the group’s final score, even if the group does not submit data to MIPS for PY 2021. This could result in the maximum negative payment adjustment of 9 percent in the 2023 payment year.

If eligible clinicians are unable to submit data for PY 2021 because of the COVID-19 pandemic, virtual groups can apply for an EUC exemption.

CMS also stated that it will continue to automatically calculate a quality score from Medicare Part B claims measures at the individual and group levels. If eligible clinicians in small practices that report Medicare Part B claims measures are only eligible to participate in MIPS through a group, then they are not covered by the EUC exemption for individual eligible clinicians.

“Some small practices may not be aware of the implications of their PY 2021 claims reporting due to some of the policies we introduced at the onset of the COVID-19 [public health emergency],” CMS stated. “As a result, these small practices may wish to request performance category reweighting on behalf of the group through the PY2021 EUC Exception Application, citing COVID-19 as the triggering event.”

Clinicians can apply for an EUC exemption because of the COVID-19 pandemic by going to qpp.cms.gov and clicking “Exception Applications” on the left-hand side of the webpage. CMS will accept applications through December 31, 2021.