MIPS Extreme and Uncontrollable Circumstances Exceptions for 2020 and 2021

The good, the bad, and the ugly — and how to avoid penalties

As COVID-19 continues to disrupt normal operations for medical practices across the country, CMS has allowed MIPS participants to use Extreme and Uncontrollable Circumstances (EUC) exceptions to forego MIPS data reporting while still avoiding penalties. Unfortunately, there are complications associated with the EUC process that can eliminate those protections if physicians and practice administrators are not aware of certain details. Read the good, the bad, and the ugly news about these exceptions to learn how you can avoid penalties.

The Good

In 2020, CMS automatically extended EUC protections to all clinicians eligible for MIPS participation.  MIPS-eligible clinicians could simply refrain from reporting any data for the 2020 MIPS program and they would automatically receive a final MIPS score equal to the performance threshold for the year, so no payment adjustments (positive or negative) would apply. No application process was required to take advantage of this special program status, though the EUC exceptions were not always implemented as expected (check the “The Ugly” section below for critical details about those scenarios).

The Bad

In 2021, CMS will again make the EUC exceptions available to MIPS-eligible clinicians, but the exceptions will not be automatically applied in 2021 as they were in 2020 — practices must submit an application to request that status for 2021 MIPS participation. Feedback so far indicates that CMS is being lenient in their judgement of EUC applicability, so most MIPS participants who have been negatively affected by the COVID-19 Public Health Emergency stand a good chance of earning EUC protection if they submit an application. If a 2021 EUC exception is granted, the covered clinicians should NOT submit any 2021 data for the MIPS categories covered by their exception, or they could deactivate their EUC protections.

Applications for 2021 EUC exceptions must be submitted by December 31, 2021.  Find more information about the 2021 EUC application process and a link to the request form on the CMS QPP website here:  https://qpp.cms.gov/mips/exception-applications

NOTE:  The application requirement only applies to EUC exceptions related to COVID-19 PHE disruptions. EUC exceptions related to FEMA disaster area status (i.e., due to non-COVID conditions such as severe storms, wildfires, etc.) will still be conferred automatically for 2021, as they have in previous years.

The Ugly

Due to system irregularities, many clinicians who should have received a neutral payment adjustment under the 2020 EUC exception policy were still scored under MIPS and penalized for insufficient data submission.  You should check your 2020 MIPS results to ensure your EUC exception was applied appropriately. If you expected to be protected by the EUC exception, but received a MIPS penalty anyway, you should immediately file a Targeted Review request with CMS to have those penalties eliminated.

You can submit Targeted Review requests for 2020 MIPS results until November 29, 2021.  You can check your 2020 MIPS results and submit Targeted Review requests by logging into your account on the CMS Quality Payment Program website (https://qpp.cms.gov/login). If needed, instructions for creating an account on the QPP website are also available on that page.

Extreme and Uncontrollable Circumstances exceptions can protect clinicians from MIPS penalties when their practice has been adversely affected by COVID-19, but that protection may require additional effort.  Clinicians who need COVID-related EUC protection for the 2021 MIPS reporting period must request the exception by December 31. If you expected to benefit from EUC protections in 2020, you should review your scores for that year; if your EUC exception was not applied appropriately, you must submit a Targeted Review request to CMS by November 29 to correct that error and protect your Medicare revenue.