• MIPS Manual 2017—ACI: Some Clinicians May Be Exempt From ACI

    Written By: Rebecca Hancock, Flora Lum, MD, Chris McDonagh, Cherie McNett, Jessica Peterson, MD, MPH, and Sue Vicchrilli, COT, OCS

    This content was excerpted from EyeNet’s MIPS Manual 2017.


    Not having an EHR system won’t usually be enough to have the ACI score reweighted. In most circumstances, if you don’t have an EHR system, your ACI score would be 0 points and your maximum final score would be 75 points (60 points for quality and 15 points for improvement activities).

    In very limited circumstances, you may be exempt from ACI. Under certain circumstances, ACI’s weighting toward your MIPS final score could be reduced to 0, with that weight transferred to the quality performance category, which would now contribute up to 85 points toward your final score. This reweighting might apply to those who suffer a significant hardship and to certain types of clinicians.

    The significant hardship exemption. Clinicians facing a significant hardship, such as insufficient internet access or extreme and uncontrollable circumstances (e.g., a natural disaster that destroys the EHR system) can apply for CMS to reweight their ACI score.

    Note: Application deadline may be changed to Dec. 31, 2017. The proposed MIPS rules for 2018 includes several provisions that—if finalized in the final rule—would apply retroactively to the 2017 performance year. These include a proposal that the deadline to apply for a hardship exemption be changed from March 2018 to Dec. 31, 2017. To apply for the exemption, go to qpp.cms.gov/about/hardship-exception.

    Certain types of MIPS eligible clinicians are exempt from ACI in 2017. CMS will automatically exempt the following types of clinician: Hospital-based clinicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists. However, if they do submit any ACI data, they will effectively have opted back in—they will receive an ACI score and their MIPS final score will be calculated in the standard way.

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    Next: ACI: MIPS Versus MU

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