2023 MIPS Hardship Application Reopened

The Centers for Medicare and Medicaid Services (CMS) announced that they are reopening the applications for 2023 MIPS extreme and uncontrollable circumstances (EUC) hardships to provide relief to those impacted by the Change Healthcare cyberattack. The application will be open for the remainder of the extended data submission period which closes April 15, 2024 at 8 pm ET.

Important Notes

  • CMS will only approve applications citing the cyberattack as the basis for requesting reweighting under the EUC.
    • EUC applications submitted for any other reason will be denied.
  • The deadline to submit a new 2023 MIPS EUC application is April 15, 2024 at 8 pm ET.
    • Retain documentation of the hardship for at least six years in case of an audit.
  • This application does not apply to any performance category for which the applicant has submitted data.
    • CMS “won’t reweight any performance category for which an individual, group or virtual group submitted data.”
    • Clinicians/groups submitting quality data codes on claims, even if only submitted prior to applying for a hardship, will be scored on Quality (1 MIPS category).
  • Applications must be submitted through your HARP account on the QPP site.
    • For more details on what this means, read the “How to Apply” section of this blog.
  • If you are granted a hardship:
    • Do not submit data in the categories for which you received a hardship exception or CMS will score those categories.
    • If you submit data on 2+ MIPS categories, CMS will score you on the reported categories and assign you a 2023 MIPS final score and 2025 payment adjustment.
    • If you submit data on 1 or fewer MIPS categories (such as small practice claims-based Quality reporters), CMS will assign you a 2023 MIPS score equal to the threshold to avoid a penalty.
    • If you get a hardship for all categories, CMS will assign you a score equal to the threshold to avoid a penalty.

Who Is Eligible for the Change Healthcare Cyberattack EUC?

If you, your group (TIN), or your MIPS APM anticipate being unable to submit data for the 2023 performance year, or complete data submission, before the extended April 15 deadline because of the Change Healthcare Cyberattack, you are eligible to apply.

CMS has provided the following examples of how you could be impacted by the Change Healthcare Cyberattack in a way that qualifies as severe enough for an EUC:

  • You’re a solo practitioner or small practice that does your own billing and submits your own MIPS data, but you’ve had to focus your administrative resources on the numerous workarounds required to get your current claims submitted.
  • You’ve hired a third-party intermediary to support your data submission, but they’re engaged in the critical work of redirecting claims and remittance through other clearinghouses so that their clients can stay financially solvent.

Reweighting Scenarios

How to Apply

If you are an Anatomy IT client, contact your MIPS Representative to complete this process for you, otherwise:

  1. Sign in to your QPP account
  2. Select “Exception Applications” on the left-hand navigation
  3. Select “Add New Exception”
  4. Select “Extreme and Uncontrollable Circumstances Exception”
  5. Complete the application at either the individual, group, virtual group, or APM Entity participation level.
    1. Note: you must complete the hardship application at the level for which you will report data to MIPS. Group applications will not apply to individual reporters and vice versa
    2. Follow this link for more information on EUC Hardship Applications (PDF)
    3. You MUST select “Ransom/Malware” as the Event Type and include “Change Healthcare Cyberattack” in the Event Description.
  6. After you submit your application, you will receive a message and an email stating that your application has been successfully submitted and is pending review.
  7. Once your application has been reviewed and a decision has been made, CMS will post the decision to your QPP account. You can also monitor your application status from there.

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 Representative if you have any questions or if you plan on using this automatic hardship. They 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!