New Practice

The Centers for Medicare & Medicaid Services (CMS) has announced a deadline extension, along with several exceptions from reporting requirements for primary care providers and other healthcare professionals participating in Medicare quality reporting programs. The changes affect upcoming measure reporting and data submission for those programs. CMS is taking these steps in an effort to provide relief for providers during the current COVID-19 pandemic.

CMS states that it is taking actions to assist the “clinicians, providers, and facilities participating in Medicare quality reporting programs including the 1.2 million clinicians in the Quality Payment Program and on the front lines of America’s fight against the 2019 Novel Coronavirus (COVID-19).” CMS Administrator Seema Verma says, “In granting these exceptions and extensions, CMS is supporting clinicians fighting Coronavirus on the front lines.”

The deadline for 2019 data submission for the Quality Payment Program (QPP) – Merit-based Incentive Payment System (MIPS) has been extended from March 31, 2020 to April 30, 2020. In addition, MIPS eligible providers who do not submit MIPS data by the new deadline will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.

Primary care providers are included in the MIPS option of the QPP if they are an eligible clinician type and meet the low volume threshold, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule.

MIPS performance is measured through the data clinicians report in four areas:

• Quality
• Improvement Activities
• Promoting Interoperability
• Cost.

 Learn more about the importance of certified EHRs for participating in MIPS.

The CMS announcement also stated that:

• It is evaluating options for providing relief around participation and data submission for 2020.
• Data submission will be optional for those programs with data submission deadlines in April and May 2020, based on the facility’s choice to report.
• No data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS’s calculations for the Medicare quality reporting and value-based purchasing programs.

CMS recognizes the burden placed on providers who are responding to the COVID-19 pandemic, in having to also focus on data collection and reporting for MIPS. The agency also acknowledges that the numbers may be somewhat skewed during a time of national emergency, particularly in regard to cost, readmissions, and patient experience. Quality measure data collection and reporting during the pandemic may not be reflective of the provider’s true performance and CMS seeks to hold healthcare organizations harmless for not submitting data during this time.

Going forward, CMS has indicated it will continue to monitor the COVID-19 situation. Healthcare providers must focus on caring for patients first and foremost so additional options will be assessed for offering additional relief to primary care providers and their staff during the emergency period.