‘Twas the Night Before MIPSmas
Before we put MIPS 2021 to bed for the year, I would like to tell you a cautionary tale. It is very important that you pay attention, or you can end up on CMS’s naughty list despite having been nice all year long.
This is a tale of misinformation and confusion that involves two issues:
Need to claim the Extreme and Uncontrollable Circumstances Exception (EUC) due to the inability of the EHR to fix an issue with its Patient Portal
The belief that filing the EUC Exception once will cover the providers in perpetuity
MIPS 2021: ‘Twas the Night Before MIPSmas
Is Your EHR Naughty or Nice?
It seems that some EHRs are falling short on their obligation to remain current regarding their conditions of certification maintenance that are required for a 2015 Edition Certified EHR. Specifically, maintaining the functionality that allows their providers to use their EHR to successfully document the MIPS Promoting Interoperability (PI) measures. An EHR must be certified or incorporate a certified third-party module to allow their users to claim that they are documenting patient encounters for MIPS Promoting Interoperability Category with a 2015 Edition Certified EHR.
The required functionalities are:
e-Prescribing – sending prescriptions electronically
The ability to generate a C-CDA and send/receive an encounter summary electronically using the Direct Protocol
The ability to invite patients and or their authorized representative to a secure patient portal and/or the use of a third-party app to obtain their encounter information via an API (Patient Engagement)
The ability to document the communication of patient information between Public Health agencies
Providers can claim exclusions due to minimal usage in a reporting period (minimum of any continuous 90-days) for all the above measures, EXCEPT for the invitation of the patient and or their authorized representative to a patient portal or the use of an API. The “Provide Patients Electronic Access measure” has no exclusion, and if not reported the entire PI category will be scored at zero, regardless of the performance score on all the other PI measures.
EHR’s Lack of Functionality
Because of failed programming logic, some EHRs have lost the ability to correctly capture the appropriate actions by the providers which document that these providers have satisfied the requirements of the Provide Patient Access measure (Invited by email). Some EHRs are advising the providers is to opt-out of the PI category without telling them that by doing so, they will miss the opportunity to submit PI and IA and potentially score in the exceptional performer range (85 to 100).
Life of EUC Exception is 1 Performance Year Only
The second issue is that EHRs are advising providers on filing for the EUC exception and giving them the impression that if they file it once, it will be good for life. Whereas the truth is that the EUC exception situation must be revisited each year. Some years providers need to file a request form, while it could be automatically applied in other years, given the providers meet certain criteria. If a Practice does not pay attention, they could get face a penalty to the tune of (-9%) due to the lack of action.
WORD OF CAUTION:
The minimum score to avoid a penalty has gone up to 75 points for MIPS 2022. We strongly advise against rushing into the decision to reweight the PI category to the Quality category. Before you opt to reweight, you must consider the scoring potential of the Quality measures that your Practice will report on. Due to the revised Quality measure benchmarks, the reweighted score might not be enough for your Practice to avoid a penalty, let alone to achieve incentives.
How Providers can Stay on the Nice List
Take charge of your MIPS score and your reputation.
Reach out to your EHR first to determine their plan to correct any deficiency in their EHR that is hindering your MIPS data reporting and the timeframe they will accomplish that.
If not satisfied with their response, you can reach out to the Testing/Certification body that certified the EHR.
If the Testing/Certification body does not respond (very low likelihood), then you can contact ONC.
Let MyMipsScore be Your Helper
As always, we are here to support you in all your efforts to satisfy MIPS and other CMS-mandated programs. Our MIPS White Glove Service is designed to provide insights on how to leverage special situations allowed by CMS for your Practice to be able to achieve the exceptional performer level (85+) if you are using a 2015 Edition Certified EHR.