Healthmonix Advisor

MIPS Performance Category Exemptions

Posted by Lauren Patrick on October 6, 2016


Recently, we discussed how otherwise eligible clinicians could be exempted from the entire MIPS program. However, under the individual performance categories for MIPS (Quality, Advancing Care Information, Resource Use, and Clinical Practice Improvement Activities), there are some special circumstances that will allow for a partial exemption. 

yellowalert.pngALERT: This post was published before the release of the MACRA final rule on 10/14/2016. Please view our MIPS website for up to date regulations.

Here are a few of these unique circumstances:

Non-patient-facing eligible clinician

Clinicians who are considered non-patient-facing only need to report one activity for the Clinical Practice Improvement Activities (CPIA).  In addition, they are exempt from the cross-cutting measure requirement of the Quality component.

"...we propose to define a non-patient-facing MIPS eligible clinician for MIPS at § 414.1305 as an individual MIPS eligible clinician or group that bills 25 or fewer patient-facing encounters during a performance period. We consider a patient-facing encounter as an instance in which the MIPS eligible clinician or group billed for services such as general office visits, outpatient visits, and surgical procedure codes under the PFS. CMS intends to publish the proposed list of patient-facing encounter codes on a CMS Web site similar to the way it currently publish the list of face-to-face encounter codes for PQRS. This proposal differs from the current PQRS policy in two ways. First, it creates a minimum threshold for the quantity of patient-facing encounters that MIPS eligible clinicians or groups would need to furnish to be considered patient-facing, rather than classifying MIPS eligible clinicians as patient-facing based on a single patient-facing encounter. Second, this proposal includes telehealth services in the definition of patient-facing encounters. [1]


Electronic Prescribing

In the proposed rule, one of the measures in the base score of Advancing Care Information (ACI)  is electronic prescribing.  This is  a required activity in order to meet the base score. The proposed rule does offer an exemption for clinicians who write a small number of prescriptions during the period.  This affords these clinicians the ability to maximize their ACI score by excluding this measure if appropriate.

"We note that the Electronic Prescribing objective would not be part of the performance score under our proposals, and thus MIPS eligible clinicians who write very low numbers of permissible prescriptions would not be at a disadvantage in relation to other MIPS eligible clinicians when seeking to achieve a maximum advancing care information performance category score. For the purposes of the base score, we are proposing that those MIPS eligible clinicians who write fewer than 100 permissible prescriptions in a performance period may elect to report their numerator and denominator (if they have at least one permissible prescription for the numerator), or they may report a null value. This is consistent with prior policy which allowed flexibility for clinicians in similar circumstances to choose an alternate exclusion (80 FR 62789)." [1]


Immunization Registry Reporting

An additional measure in the base score of the Advancing Care Information (ACI) component is Immunization Registry Reporting.  This is also a required activity in order to meet the base score.  The proposed rule allows clinicians who do not administer immunizations to exclude this measure in their reporting.  This is important in that the base score, as proposed, is an all-or-nothing score that significantly affects the clinicians overall score.

"In addition, in the 2015 EHR Incentive Programs final rule, we adopted a set of exclusions for the Immunization Registry Reporting measure under the Public Health and Clinical Data Registry Reporting objective (80 FR 62870). We recognize that some types of clinicians do not administer immunizations, and are therefore proposing to maintain the previously established exclusions for the Immunization Registry Reporting measure. We are therefore proposing that these MIPS eligible clinicians may elect to report their yes/no statement if applicable, or they may report a null value (if the previously established exclusions apply) for purposes of reporting the base score." [1]


Topics: MACRA & MIPS, Policy, Eligibility