ACI Exemptions under MIPS

Following ASA’s advocacy efforts in 2012, CMS created a hardship exemption for anesthesiologists for five years in the publication of the Meaningful Use Stage 2 Final Rule.

Beginning with the first MIPS performance period on January 1, 2017, this blanket exemption for anesthesiologists who had a specialty designation under the Provider, Enrollment, Chain and Ownership System (PECOS) designation of “05” will no longer apply.

Under MIPS, there are several exceptions for MIPS eligible clinicians that would reweight the Advancing Care Information performance category, including:

  1. Hospital-based MIPS eligible clinicians (Hospital-based MIPS eligible clinicians are those who furnish 75 percent or more of his or her covered professional services in sites identified with Place of Service Codes 21 (Inpatient Hospital), 22 (On campus outpatient hospital), or 23 (Emergency room)
  2. Lack of Face-to-Face Interaction with Patients (Fewer than 100 patient-facing encounters in a given performance period) 
  3. Insufficient Internet Access (Practicing in an area without sufficient Internet access or facing insurmountable barriers to obtaining infrastructure (lack of broadband, etc.))
  4. Extreme and Uncontrollable Circumstances (Natural disasters, practice or hospital closure, severe financial distress, EHR certification/vendor issues)
  5. Lack of Control over the Availability of CEHRT (Inability to control CEHRT availability in over 50% of patient encounters)

For exceptions 1 and 2, ECs can check their exemption statuses on the Quality Payment Program website.

CMS requires an exception application for exception 3, 4 and 5 listed above. Practices and individuals are required to submit an exception application each year to be eligible for the reweighting. 

A CMS exception application will be available online prior to the payment adjustment period (first payment period is 2019 based upon 2017 performance period).