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A guide to new MIPS/MACRA changes

The public health emergency resulting from the COVID-19 pandemic has affected most independent practices. In response, the Centers for Medicare & Medicaid Services (CMS) has made some adjustments and added flexibilities for the Quality Payment Program (QPP). The QPP was created by the Medicare Access and CHIP Reauthorization Act (MACRA) and creates two payment pathways for physicians—alternative payment models (APMs) and the Merit-based Incentive Payment System (MIPS).

Not all healthcare providers have been affected to the same extent during the coronavirus outbreak. CMS recognizes this fact and in response will be using the Extreme and Uncontrollable Circumstances policy for the 2020 performance year. This policy allows clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more Merit-based Incentive Payment System (MIPS) performance categories due to the current COVID-19 pandemic public health emergency.

  • Extreme and Uncontrollable Circumstances Exception – Allows you to request reweighting for any or all performance categories if you encounter an extreme and uncontrollable circumstance or public health emergency, such as COVID-19, that is outside of your control.
  • MIPS Promoting Interoperability Performance Category Hardship Exception – Allows you to request reweighting specifically for the Promoting Interoperability performance category. Qualifying criteria includes being a small practice (15 or fewer providers under a single TIN).

In addition, CMS is proposing flexibilities in the CY 2021 Physician Fee Schedule Notice of Proposed Rulemaking (NPRM), including:

  • Allowing APM Entities to submit an extreme and uncontrollable circumstances exception application for reweighting of MIPS performance categories for the 2020 performance year.
  • Revising the current Complex Patient Bonus to account for additional complexity in treating patients during the COVID-19 pandemic. As proposed, clinicians, groups, virtual groups and APM Entities could earn up to 10 bonus points towards their final score for the 2020 performance year.

For accountable care organizations (ACOs), groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients, there are also changes. CMS considers all ACOs to be affected by the COVID-19 pandemic public health emergency for performance year 2020 so the Shared Savings Program extreme and uncontrollable circumstances policy applies to them as well.

As part of the CY 2021 PFS NPRM, CMS proposes to waive the requirement for ACOs to field a Consumer Assessment of Healthcare Providers and Systems (CAHPS) for ACOs survey for performance year 2020. Consequently, ACOs would receive automatic full credit for the patient experience measures.

CMS also recognizes the expanded use of technology during the COVID-19 pandemic public health emergency and will include additional communications technology-based services and telephone evaluation and management services in the MIPS patient assignment methodology for CMS Web Interface and the CAHPS for MIPS survey.

The expanded list of services/codes allows telehealth encounters for Clinical Quality Measures calculations. In Elation, 12 of our 13 eCQMs can be addressed through video/phone encounters including, but not limited to, the following common scenarios. (BMI Assessment is the only Elation eCQM that needs to be addressed during an in-person visit.)

  • A video encounter that is coded with a regular office-level E/M code 
  • A phone call that is coded with 99441-99443, G0438, G0439.

If your patient has at least one of these types of visits, you can still submit quality measures for that patient.

The deadline to apply for either exclusion option is December 31, 2020. You must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application.