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MIPS Extreme and Uncontrollable Circumstances

The Centers for Medicare & Medicaid Services (“CMS”) is required to implement a quality payment incentive program. One of the primary programs set forth by CMS is the Merit-based Incentive Payment System (“MIPS”). MIPS evaluates qualifying clinicians based on (1) quality; (2) promoting interoperability; (3) improvement activities; (4) and cost. The purpose of the MIPS program is to encourage higher quality and more efficient care.

On June 24, 2020, and in response to the 2019 Novel Coronavirus (“COVID-19”) pandemic, CMS announced the “MIPS Program Extreme and Uncontrollable Circumstances Exception.” If a MIPS-eligible clinician has been affected by an extreme or uncontrollable circumstance, they may submit an application for the re-weighting of the above-four MIPS performance categories. This re-weighting will offset the negative impacts COVID-19 has had on MIPS clinicians’ reimbursements. CMS defines an extreme and uncontrollable circumstance as a circumstance that would:

  • Cause a clinician to be unable to collect information necessary to submit for a MIPS performance category;
  • Cause a clinician to be unable to submit information that would be used to score a MIPS performance category for an extended period of time; and/or
  • Impact a clinician’s normal processes, affecting their performance on cost measures and other administrative claims measures.

If a clinician believes one of the above situations has occurred to them, they should apply, unless the exception gets applied automatically. It applies automatically to eligible clinicians who are located in a CMS-designated region that was affected by an extreme and uncontrollable event during the 2020 performance period. Otherwise, clinicians should apply through the HCQIS Access Roles and Profile (“HARP”) account. Information for how to apply is found on the CMS quality payment program website. Applications are open until December 31, 2020.

In addition to the Extreme and Uncontrollable Circumstances exception, CMS has already introduced a new high-weighted COVID-19 clinical trials improvement relief effort. A clinician must attest that they have: (1) participated in a COVID-19 clinical trial and entered the data into a data platform, or (2) treated COVID-19 patients and submitted their COVID-19 information into a clinical data registry.

For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding MIPS and other quality-based programs. Wachler & Associates will continue to stay up to date with all COVID-19-related news.  If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or


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