April 18, 2023
Physicians and physician groups affected by the COVID-19 pandemic will again this year be able to apply for a Medicare hardship exception for the 2023 performance year.
Merit-based Incentive Payment System (MIPS) eligible clinicians, groups, and virtual groups may apply to reweight any or all MIPS performance categories if they’ve been affected by extreme and uncontrollable circumstances, including the COVID-19 pandemic. Extreme and uncontrollable circumstances are defined as rare events entirely outside of your control and the control of the facility in which you practice.
As a result, physicians and group practices who apply for an exception will be able to avoid a MIPS penalty in 2025 based on 2023 performance. The exception will not be automatic, and physicians and groups interested in obtaining one must request reweighting of one or more MIPS performance categories due to the COVID-19 public health emergency. Requesting reweighting of all four MIPS performance categories will avoid a MIPS penalty in 2025.
The Centers for Medicare and Medicaid Services (CMS) expects the application to be available in spring 2023, and interested parties can subscribe to CMS’s Quality Payment Program listserv to receive updates.
CMS estimates that up to one-third of MIPS-eligible clinicians would receive a penalty up to 9% due to increasingly stringent requirements for participating in MIPS for 2023, and small and rural practices, as well as those serving underserved populations, would have been disproportionately penalized.