Understanding the 2023 MIPS Hardship Exceptions

The Centers for Medicare and Medicaid Services (CMS) has begun accepting applications for the 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception and MIPS Promoting Interoperability Performance Category Hardship Exception. As a practice manager or MIPS provider, understanding these exceptions is crucial for avoiding penalties and maximizing reimbursement. Let’s delve deeper into these hardship exceptions, explaining why they exist, the eligibility criteria, and how to apply.

MIPS is intended to incentivize physicians and clinicians to provide high-quality care to patients. Eligible providers can earn increased reimbursement through MIPS by meeting certain performance thresholds. However, some providers may experience unforeseeable circumstances that make it difficult or impossible to meet those thresholds. CMS provides hardship exceptions to ensure providers are not unfairly penalized.

Let’s start with the Extreme and Uncontrollable Circumstances Exception. Providers may be eligible if they have experienced a natural disaster, public health emergency, or other unforeseeable events that significantly impact their ability to collect data or meet performance thresholds. Providers must document the circumstances and provide evidence demonstrating that the circumstances were beyond their control. At least one of the following scenarios must have significantly impacted a healthcare provider's ability to participate in MIPS reporting.?

• Inability to gather essential information needed to submit for a MIPS performance category
• Extended inability to submit information necessary to score a MIPS performance category (for example, not being able to collect data for the quality performance category for three months)
• Any disruptions to the normal process that could potentially affect performance on cost measures and other administrative claims measures

The Promoting Interoperability Performance Category Hardship Exception is available to providers who need to opt-out of the category for reasons outside their control. Examples might include a lack of access to high-speed internet, a lack of control over electronic health record (EHR) design, or insufficient patient engagement. To apply, providers must describe the circumstances and provide supporting documentation.

These exceptions do not exempt providers from participation in MIPS. Providers who receive a hardship exception for Promoting Interoperability category will still need to submit data for the other categories. Providers who receive an Extreme and Uncontrollable Circumstances Exception may have their scores reweighted to place more emphasis on the remaining categories.

To apply for a hardship exception, providers must apply to CMS before 8 p.m. on January 2, 2024. The application must include documentation supporting the hardship exception request. Providers should work with EHR vendors or MIPS consultants to gather and submit the proper documentation to CMS.?

CMS’s 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception and MIPS Promoting Interoperability Performance Category Hardship Exception are designed to provide relief for providers who experience unforeseeable circumstances that impact their performance in MIPS. Understanding the eligibility criteria, documentation requirements, and application deadlines is essential for avoiding penalties and maximizing reimbursement. As a practice manager or MIPS provider, it’s worth reviewing these rules and regulations to ensure your practice is prepared. Chirpy Bird offers a free Ebook designed to help you understand MIPS activities. Download it and contact us to learn how we can help you manage MIPS.