Payment & Delivery Models

Physicians get extra time to file MIPS hardship requests

Andis Robeznieks , Senior News Writer

What’s the news: The Centers for Medicare & Medicaid Services (CMS) has reopened its reweighting request period for performance categories during the 2020 Merit-based Incentive Payment System (MIPS) program year.

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CMS acknowledged that the COVID-19 pandemic continues to disrupt practice operations and many physicians did not have time to submit an extreme and uncontrollable circumstances (EUC) exception request before the previous March 31 deadline for the 2020 MIPS program, which affects 2022 Medicare payments.

The reopening also allows small practices or individual physicians who may have inadvertently filed incorrectly to refile their reweighting request.

Under the EUC policy, physicians, groups, virtual groups and alternative payment model (APM) entities have through Nov. 29 to submit a request for the reweighting of one or more of the MIPS performance categories, which are: quality, cost, promoting interoperability, and improvement activities.

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Physicians need to access the CMS targeted review form to submit a EUC reweighting request for payment year 2020. Then they need to:

  • Select the performance categories for which you’re requesting reweighting.
  • Select “Extreme and uncontrollable circumstances” in the issue selection.
  • State explicitly in the description that they’re submitting a EUC application due to the continuing COVID-19 public health emergency.

Why it’s important: MIPS uses a scoring system designed to reward physicians and other clinicians for improving the quality of the health care they deliver.

Many individual physicians and small practices may have incorrectly filed a EUC application as a group. Because only small practices and physicians reporting as individuals can submit quality measures through Part B claims, CMS was able to identify the errors because many small practices used the claims-reporting option but then did not report group-level data for the other performance categories.

The AMA encourages these small practices to request performance category reweighting on behalf of the individual physicians in the group and to take advantage of the extended flexibility for the 2020 MIPS program to avoid a negative payment adjustment for 2022. The AMA also has urged CMS to contact each affected physician directly to help ensure small practices do not inadvertently receive a 2022 MIPS penalty.

For program year 2020, CMS applied its automatic EUC policy to all individual MIPS-eligible physicians to reweight to 0% any performance category for which those physicians did not submit data—ensuring that these performance categories do not contribute to their final score. The automatic EUC policy, however, only applies to physicians who were eligible to participate as individuals and did not submit any data. It does not apply to those who participate as a group, APM entity or as part of a virtual group.

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Recognizing that the COVID-19 pandemic continues to disrupt physician practices, the AMA is urging CMS to extend the automatic EUC policy to the 2021 MIPS performance period, which will affect physicians’ 2023 payment adjustment.

The AMA believes physicians should be provided maximum flexibility with avoiding a MIPS penalty as physicians continue to be on the frontline with treating patients with COVID-19 and the multiple challenges with providing care during the public health emergency.

Learn more: AMA advocacy efforts to refine MIPS seek to make the program more clinically relevant, less burdensome and more transparent have continued through the pandemic. So have efforts to promote regulatory and financial relief for physician practices facing economic hardships because of COVID-19. Find additional guidance from the AMA on understanding MIPS.