Physicians eligible to participate as individuals in Medicare’s Merit-Based Incentive Payment System (MIPS) will automatically qualify for an exemption due to the ongoing COVID-19 pandemic thanks to a recent Centers for Medicare & Medicare Services (CMS) announcement.
CMS’ application of the MIPS “extreme and uncontrollable circumstances” policy for the 2021 performance period means all such physicians will avoid a payment penalty in 2023.
The news will come as a relief to most physicians, says Texas Medical Association Vice President of Medical Economics Robert Bennett. However, other physicians who must apply for an exemption will face an administrative burden if they choose to do so.
Medicare will automatically identify those eligible to participate in MIPS as individuals, unless they already have submitted data in two or more performance categories or have a higher final score from participating in MIPS as a group or entity. In those cases, they will have to apply for an exemption.
This is not the first time CMS has invoked the policy. Since MIPS’ launch in 2017, the federal agency has done so for hurricanes, wildfires, and – last year – COVID-19.
Eligible participants who would have incurred a payment penalty without the hardship exemption won’t get a penalty, but won’t get an incentive payment, either, in 2023 for their 2021 performance. Those who have achieved success by participating in MIPS will still be eligible for incentive payments, as CMS has allocated $500 million for participants who meet the performance threshold (60 points for the 2021 performance period).
Mr. Bennett equates the policy to a pass/fail option that still allows students to opt for letter grades, depending on their standing in the class. However, he cautions it also creates an administrative hurdle for some physicians already struggling with the financial toll of the pandemic if the policy does not apply automatically to them.
Specifically, that includes MIPS physicians who:
- Have already submitted Part B quality measures through their 2021 Medicare claims; and
- Are participating as part of a group, virtual group, alternative payment model entity, or Medicare Shared Savings Program accountable care organization.
These physicians will need to request a hardship waiver for the 2021 MIPS performance period before Dec. 31, citing COVID-19 as the triggering event. Doing so may require providing additional information.
For more information, consult CMS’ 2021 MIPS Extreme and Uncontrollable Circumstances Application Guide or the Quality Payment Program help desk.