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MIPS Eligible Clinicians ... Don’t Lose 9% of Your Medicare Payments!

November 06, 2020

MIPS Eligible Clinicians ... Don’t Lose 9% of Your Medicare Payments!
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You have until February to apply for a MIPS Exception! 

To avoid up to a 9% payment adjustment in 2022 on Medicare payments, MIPS eligible providers and groups must:

  • Report data to CMS (in two or three performance categories) by March 31, 2021 TO
  • Earn a score of at least 45 points across two, three or four performance categories OR
  • Be granted an exception!

Extreme and Uncontrollable Exception

Automatic Exception

For performance year 2020, CMS has declared all 64 parishes in Louisiana to be a CMS-designated region affected by an Extreme and Uncontrollable event - Hurricane Laura. The individual MIPS eligible providers in Louisiana do not have to apply for an exception to avoid a penalty in 2022. 

The individual MIPS providers in the disaster area will NOT be penalized if they fail to earn 45 points in the MIPS program, as long as they do not:
- Submit data in at least two categories in 2020
- Report as a group in 2020
- Report as a virtual group in 2020 

This exception for the Louisiana providers is automatic! No application is necessary.

Applying for an Exception 

If the COVID-19 pandemic and/or recent storms prevent a MIPS eligible clinician or group (outside of Louisiana) from collecting 2020 MIPS data, they can submit an application to have all, some or one of the MIPS performance scores reweighted to 0%. In turn, instead of a penalty (negative payment adjustment), an eligible clinician or group would receive a neutral or 0% payment adjustment in 2022.

At this time, the COVID-19 pandemic is not considered a CMS emergency for purposes of an automatic exemption, but it can be an extreme and uncontrollable circumstance and can be the basis for a MIPS exception, but they have to apply. The application does not require documentation or “proof” of the circumstances. However, retain documentation for your own records and for data validation or audit purposes.
 

General Information

  • The online applications for both exceptions are very easy and straightforward. They can be completed in less than 15 minutes.
  • Most providers are receiving decisions back within minutes of submitting applications.
  • The deadline for the Extreme and Uncontrollable applications was extended to February 1, 2021. 
  • Applications must be submitted through the QPP portal using a HARP account.
  • Eligible clinicians, groups or their (practice staff) representatives can contact the QPP Help Desk for assistance and step-by-step guidance through the exception application process.
  • Providers in the disaster area should verify their eligibility status on the QPP Participation Status Tool.

IMPORTANT NOTE: If an eligible clinician or group is granted the exception, but then submits data, the data submission will override the re-weighting on a category by category basis. 

For more questions about exception applications or MIPS reporting, contact LAMMICO Practice Management Specialist, Natalie Cohen, MBA, MHA, at 504.841.2727 or ncohen@lammico.com.

Participation in the Quality Payment Program may help you mitigate your malpractice risk through tracking and improving quality care (Quality measures), increasing patient engagement and satisfaction (Improvement Activities) and improving communications using secure electronic transmissions between providers and with patients (Promoting Interoperability). 

This information is accurate as of January 5, 2021. 


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