CMS Offering Hardship Exceptions for MIPS PY2023

MIPS-eligible clinicians, groups and virtual groups may be able to apply for one of two possible exceptions. In certain instances, exceptions may be granted automatically, as noted below.

Clinicians may request reweighting for any or all performance categories by applying for the MIPS Extreme and Uncontrollable Circumstances Exception. CMS defines “extreme and uncontrollable circumstances” as rare events entirely outside of clinicians’ control and the control of the facility in which they practice. Examples would be circumstances that

• cause the clinician to be unable to collect information necessary to submit for a MIPS performance category; 
• cause the clinician to be unable to submit information that would be used to score a MIPS performance category for an extended period (for example, if the clinician was unable to collect data for the quality performance category for three months); and/or
• impact the clinician’s normal process, affecting performance on cost measures and other administrative claims measures.

Alternative payment model entities also may apply for an EUC exception, but they must request that all performance categories be reweighted.

Alternately, clinicians may request that only the promoting interoperability performance category be reweighted to 0% by applying for the MIPS Promoting Interoperability Performance Category Hardship Exception. To qualify, practices must

• have decertified EHR technology;
• have inadequate Internet connectivity;
• face extreme and uncontrollable circumstances (e.g., natural disaster, practice closure, severe financial distress, vendor issues); or
• not have control over the availability of certified EHR technology. Simply lacking the required CEHRT does not qualify a practice for the exception.

CMS automatically reweights the promoting interoperability category for small practices of 15 or fewer eligible clinicians. Clinicians can review whether they’ve been determined to be a small practice in the QPP Participation Lookup Tool.

APM entities are not eligible to apply for the promoting interoperability performance category exception.

MIPS-eligible clinicians located in a CMS-designated region that has been affected by an EUC event (e.g., an event the Federal Emergency Management Agency has designated as a major disaster) during the 2023 performance year will receive the automatic EUC exception. The automatic EUC exception policy does not apply to groups, virtual groups or APM entities.