Medicare Allowing MIPS Relief for “Uncontrollable Circumstances” in 2022
By Sean Price

Having some prohibitive trouble reporting your 2022 data for Medicare’s Merit-Based Incentive Payment System (MIPS)? Maybe the COVID-19 pandemic caused it. Maybe it stems from a natural disaster in your region. Maybe your technology vendor has gone out of business or had some other problem.

For these and other setbacks, physicians may be able to catch a break. The Centers for Medicare & Medicaid Services (CMS) is accepting 2022 applications for its MIPS “extreme and uncontrollable circumstances” exception and the MIPS “promoting interoperability performance category hardship” exception. Scores for 2022 will affect 2024 payments.

Applications are due by Dec. 31. You also can refer to the Quality Payment Program’s COVID-19 Response webpage.

Eligible clinicians, groups, and virtual groups can apply to reweight any or all MIPS performance categories, Medicare states on its website. But what is an “extreme and uncontrollable circumstance”? 

The agency defines it as a rare event entirely outside your control and the control of the facility in which you practice. These circumstances must:

  • Cause you to be unable to collect information necessary to submit data for a MIPS performance category;
  • Cause you to be unable to submit information that would be used to score a MIPS performance category for an extended period; or
  • Impact your normal process, affecting your performance on cost measures and other administrative claims measures. 

“CMS is trying to be very lenient for those who have circumstances beyond their control,” said Shannon Vogel, the Texas Medical Association’s associate vice president for health information technology. That leniency is targeted specifically at “physicians in small practices who have the least amount of tech support,” she added.

Physicians who have faced a setback but who have good quality data for 2022 and still want to report are free to do so, Ms. Vogel says. But any physicians applying for an extreme and uncontrollable circumstances exception need to document it.

“I always tell physicians that in the unlikely event that you’re audited, you want to be prepared with documentation for why you claimed that reason,” she said.

That documentation needs to be saved for at least six years in case CMS does audit, she says.

CMS has invoked the extreme and uncontrollable circumstances policy multiple times since MIPS’ first performance year in 2017, including for hurricanes, wildfires, and COVID-19.

Last Updated On

June 01, 2022

Originally Published On

June 01, 2022

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Sean Price

Reporter

(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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