New Hardship Option Available for MIPS
The Centers for Medicare and Medicaid Services (CMS) has finalized a policy allowing MIPS participants to request a hardship if their performance data is not submitted due to circumstances beyond their control involving a third party intermediary, such as a QCDR or registry. This policy only applies if you delegated data submission to a third party intermediary and the intermediary failed to submit the data on time. You must have a written agreement with the intermediary to demonstrate this arrangement.
This policy will be effective starting with the 2024 performance year and will allow affected clinicians to request the reweighting of one or more of the Quality, Improvement Activities (IA), and Promoting Interoperability (PI) performance categories.
Factors CMS Considers in the Hardship Request
CMS will consider the following factors when determining whether to grant the hardship:
- Whether the clinician knew or should have known about the issue with the third party intermediary,
- Whether the clinician took reasonable efforts to resolve the issue, and
- Whether the issue resulted in no data being submitted by the performance category deadlines.
Below are some examples of circumstances that may merit a hardship under this policy. CMS will only consider these circumstances after evaluating the factors above. If you had sufficient time and the ability to correct any of the following issues, CMS will not approve the hardship.
Circumstances that may warrant a hardship include:
- A critical systems failure,
- The third party intermediary going out of business,
- Refusal by the third party intermediary to release collected data for submission, and
- Any other factors that CMS determines to be beyond the clinician’s control.
CMS will only approve the hardship if you provide evidence of a written agreement between you and the third party intermediary, showing that you delegated the data submission to them and they agreed to submit the data on your behalf.
Reweighting Scenarios
How to Apply
Unlike standard hardship applications, this application is not submitted through your QPP account. Hardship requests and supporting documentation for circumstances falling under this policy must be submitted via the QPP Help Desk at QPP@cms.hhs.gov.
You must submit your request after the data submission deadline for the performance period, but no later than November 1st of the year prior to the associated payment year. For example, if you’re requesting this hardship for the 2024 performance year, you must submit the request between March 31, 2025 and November 1, 2025.
Note that this is different and separate from the submission process for the Extreme and Uncontrollable Circumstances (EUC) hardship application and the Promoting Interoperability (PI) exception application.
Important Notes
- This hardship only applies if you did not know (or had no reason to know) of any issues with the third party intermediary prior to the data submission deadline. If you were aware of an issue, you need to demonstrate that you took steps to correct it.
- For example, CMS will not approve the hardship if a third party intermediary terminates your contract mid-year. CMS expects you to have made efforts to replace the intermediary.
- The issue with the third party intermediary must be outside of your control.
- For example, if you failed to provide complete data to the third party intermediary, this policy would not apply.
Next Steps
- Share this information with your colleagues.
- Subscribe to our blog to get alerts on this and other important issues. You can subscribe using the field in our website footer below.
- If you are an Anatomy IT client
- Contact your MIPS Expert if you have any questions or if you plan on using this hardship. Your MIPS Expert will help you evaluate your eligibility and retain the necessary documentation on your behalf.
- If you are not an Anatomy IT client
- Contact us to learn more about our MIPS Success Plan and to reap the rewards of our combined decades of experience.
If you have any questions on this, let us know!
Written By: Sarrah Hakim, MHSA
About the Author: Sarrah is a Manager of Health Policy at Anatomy IT.
