What Medicare Providers Need to Know About MIPS EUC

If you are one of the many thousands of providers who participate in the Merit-based Incentive Payment System (MIPS) program, you may have heard of the Extreme and Uncontrollable Circumstances (EUC) exception. This relief measure benefits providers who are still recovering from the effects of the COVID-19 pandemic, but it can apply to other catastrophic events as well. Qualifying events are listed through the QPP Listserv. There are some recent updates to be aware of regarding MIPS EUC in 2023. 

What Does the EUC Do for MIPS Participants? 

While trying to keep your practice functioning during the substantial disruption of a pandemic, MIPS scoring is not at the forefront of one’s mind. But not maintaining MIPS performance thresholds can result in a penalty. Thankfully, there is a MIPS Extreme and Uncontrollable Circumstances (EUC) that can provide some leeway for such situations.  

CMS defines “extreme and uncontrollable circumstances,” as, “rare events entirely outside of your control and the control of the facility in which you practice.” The EUC exception allows providers to request reweighting for any or all of the performance categories if you have been operating under uncontrollable circumstances.      

Is it Too Late for MIPS Participants to Apply for EUC for the Year 2022? 

Providers who have not yet turned in an exception application for performance year 2022 still have time to do so at the time of this article’s publication. Applications for COVID-19 hardship are still being accepted per a MIPS extension. The deadline to submit the application has been extended to March 3, 2023. However, applicants do not have until midnight of March 3rd to submit as the deadline for that date is 8:00 p.m. EST.  

Can MIPS Participants Get an EUC Exception for COVID-19 in 2023? 

Yes. Under the Biden administration, the EUC hardship has been extended into 2023. This applies to practices still experiencing impact from the pandemic.  

To Which Providers Does the EUC Exception Apply? 

Practices who believe they have been impacted by an extreme and uncontrollable circumstance may apply for this exception for either traditional MIPS or the APM Performance Pathway (APP). 

Any data submitted for an individual, group, or virtual group will be scored by the CMS.  Also note that APM entities whose application is approved will not experience an override of performance category reweighting because of data submission. 

What About the MIPS Performing Interoperability (PI) Exception? 

There are two different hardship exceptions available to MIPS participants. 

• The MIPS Extreme and Uncontrollable Circumstances (EUC) exception application – As stated earlier, this application applies to those providers who were impacted by an event beyond their control and want to request reweighting for any or all MIPS performance categories 
• The MIPS Performing Interoperability category hardship exception application – As the title would indicate, this exception is exclusive to the PI category. However, the reason for this exception must be one of the following: 
• Decertified EHR 
• Internet connectivity is insufficient 
• Extreme and unusual circumstances such as a natural disaster, unforeseen practice closure, extreme financial difficulty, or problems with vendors 
• Due to reasons beyond the provider’s control, they cannot obtain certified electronic health record technology (CEHRT) 

How Does This Impact Those Who Do Not Need a Hardship Exception? 

While the extension of the hardship exceptions is great news for some providers, there is a downside for others who fall outside of the applicant group. Because these hardship exemptions are intended to help providers avoid a penalty for exceptional circumstances, this affects providers on the pathway to a bonus payment. The penalties collected are distributed among those who earn the payment adjustment. With an increase of neutral results from quality scoring, this means fewer penalties flowing to the bonus payment pool.