2020 MIPS Hardship Exemption Guide

CMS has allowed individual eligible clinicians and their groups to apply for a hardship exemption for the MIPS reporting year 2020. If the COVID-19 pandemic prevents you or your group from collecting 2020 MIPS performance period data for an extended period of time, or could impact your performance on cost measures, you can submit an extreme and uncontrollable circumstances application through December 31. Applications are submitted through a group’s HARP account.

  • Applications may be submitted for any MIPS category to be reweighted to 0 points. The remaining categories will be reweighted.
  • An individual clinician or group must be scored on at least two performance categories to earn a MIPS final score greater than the performance threshold.
  • When fewer than two performance categories can be scored, the final score for the 2020 MIPS performance period will result in a neutral payment adjustment in 2022.       

Documentation of a hardship is not required at the time of application but groups should maintain documentation demonstrating that COVID-19 prevented the group from collecting 2020 MIPS data.

  • If you want to apply for a hardship exemption, make sure to document why you are unable to collect data or complete an improvement activity.
  • CMS will consider the length of time an applicant was impacted by an extreme and uncontrollable circumstance and how it impacts their ability to submit data (e.g. performance period for Quality is 12 months while the performance period for Improvement Activities is 90 days).

Hardship circumstances described by CMS include that COVID-19 has:

  • Caused you to be unable to collect information necessary to submit for a MIPS performance category;
  • Caused you to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example, if you were unable to collect data for the Quality performance category for 3 months), and/or;
  • Impacted your normal processes, affecting your performance on cost measures and other administrative claims measures; and
  • CMS has indicated that each application is unique and the agency will review each application on its own merits.

Individual and Group Considerations:

  • Why you may wish to take a hardship exemption:

    ECs and groups that have encountered obstacles to collecting MIPS data because of the COVID-19 pandemic may apply for a hardship exemption. As described by CMS, CMS is looking for technical challenges to collecting data and not necessarily an economic hardship or a reduction in case volumes. For example, a hardship exemption is meant to apply to scenarios where the individual or group could not collect quality data for several months or if the group could not complete an improvement activity because of COVID-19 for a 90-day period or for 50% of its NPIs.

  • Why you may not want to take a hardship exemption:

    There is some uncertainty with the hardship exemption, including how CMS will review, approve and audit practices. Practices should take into account several contingencies. First, if you receive a hardship exemption, will the ceasing of data collection this year prevent or delay you from collecting data in 2021? Second, have you documented why you could not collect data for a significant amount of time during the reporting year? Or, if you are looking at cost data, could the services you provided in 2020 be attributed to you through the cost category (e.g. reporting higher rates of E/M codes, providing the bulk of critical care services)? Third, if you believe that you will or have scored high in previous years, earning a modest bonus payment in 2022 based upon your 2020 performance may be a driving factor to continue the program. There are other questions that individuals and groups may consider when making a decision.

  • Check your 2019 Performance Feedback Report:

    In August 2020, CMS will provide you with performance feedback based on the data you submitted for Performance Year 2019. You will be able to use this feedback to improve your care and optimize the payments you receive from CMS. The targeted review process opens, and will continue for 60 days, after the release of the performance feedback. EC and groups should review these scores to determine if the facility-based scoring option was applied to their practice and if it had a positive impact on their scores. Facility-based scoring is applied as a replacement for quality and cost performance categories, when facility-based scoring is higher than the submitted quality measures and cost tallies. To receive facility-based scoring, the individual or group must submit data for at least two performance categories.

  • Determine the questions CMS asks to substantiate your hardship exemption

    Log-on to your HARP account to check the questions CMS asks when applying for a hardship exemption. Make sure that you provide a detailed explanation of your request and you have appropriate documentation to substantiate the hardship exemption. If CMS denies your exemption request, you may not reapply later in the year.

  • Apply by October 1, 2020

    Although you may apply for a hardship exemption through December 31, 2020, we recommend that you apply no later than October 1, 2020. It is expected that CMS will take some time to review and approve any hardship exemptions. If CMS denies you or your group a hardship exemption, you will still need to complete and document an improvement activity for at least a 90-day period. Make sure that you continue to collect data as best as you can until you know if your hardship exemption for any or all of the MIPS performance categories is approved.