Just as it seemed like physician practice patterns were getting back to normal, the late-year Omicron surge skewed the Merit-based Incentive Payment System (MIPS) quality data for 2021. With that in mind, the Centers for Medicare & Medicaid Services (CMS) has taken steps enabling physicians to minimize the impact of 2021 quality data on their future Medicare payments.
MIPS, 101: Under the Medicare Access and CHIP Reauthorization Act (MACRA), physicians earn Medicare payment bonuses, payment penalties, or no payment adjustments at all based on a yearly MIPS score of 0 to 100, allocated among quality, meaningful EHR use, resource use, and clinical practice improvement activities.
As in 2020, COVID-19 wrought havoc on MIPS scores in 2021. The saving grace is that providers who experience outlier performance years due to circumstances beyond their control can apply for what are called extreme and uncontrollable circumstances (E&C) waivers allowing for adjustment of that data.
In November, CMS provided an automatic exemption to individual physicians for 2021 to account for Omicron. However, relief didn’t extend to physician groups, who had until December 31, to apply for a waiver. Of course, many physicians were too busy putting out Omicron fires to file for waivers. So, CMS has now agreed to extend the waiver application deadline for not only physician groups but also virtual groups and alternative payment model (APM) entities to March 31. If the waiver is granted, their data will be re-weighted to account for the impacts of COVID-19. In addition, physician groups that didn’t submit data by the original Dec. 31 deadline won’t be hit with a penalty.
Learn more in the upcoming April 2022 issue of National Lab Reporter.