This content is excerpted from EyeNet’s MIPS 2023: A Primer and Reference; also see the Academy’s MIPS hub page.
In some circumstances, CMS can reweight the performance categories. If CMS determines that you shouldn’t be scored on a performance category, it can reduce that category’s weight in your MIPS final score to zero and increase the weight of one or more of the other performance categories as shown in “How the Performance Categories Are Weighted,” below.
When does CMS reweight performance categories? Reweighting may occur in the following circumstances:
- When you can't be scored on any cost measures. If you are not a cataract surgeon or an oculofacial specialist, you are unlikely to meet the case minimum for any measures in the cost performance category. And if you can’t be scored on any cost measures, the cost score’s weight in your MIPS final score will be redistributed to one or more of the other performance categories as shown below.
- When a promoting interoperability exception applies. If you are in a small practice, your promoting interoperability score will automatically be reweighted to zero. This automatic reweighting also applies to certain clinician types, but none of them is likely to be employed in an ophthalmology practice. And CMS has specified certain circumstances in which you can apply for a promoting interoperability exception—including, for example, if your EHR system was recently decertified.
- Emergencies. CMS can reweight performance categories if it determines that “extreme and uncontrollable circumstances” apply.
Table: How the Performance Categories Are Weighted
“Extreme and Uncontrollable” Circumstances
What if extreme circumstances beyond your control limit your ability to participate in MIPS? You can apply to have your performance categories reweighted if you have difficulty reporting one or more performance categories due to “extreme and uncontrollable circumstances.” CMS started accepting applications in May. The application period will close at 8:00 p.m. E.T. on Jan. 2, 2024.
What is considered extreme and uncontrollable? It must be a rare event that is entirely outside of the control of yourself and of the facility where you work. The circumstances must prevent you—either altogether or for an extended period of time—from collecting information that you need to submit for a performance category. For example, a fire that destroys the only facility where a clinician works could be considered extreme and uncontrollable, but the inability to renew a lease for that facility wouldn’t. CMS will take into account the type of event, date of event, length of time over which the event took place, and other details that impact your ability to report each performance category.
During a widespread catastrophe, CMS may waive the application requirement for individuals. For example, if the Federal Emergency Management Agency declares a major disaster or public health emergency, CMS may decide to implement an automatic extreme and uncontrollable circumstances policy, which would mean that affected clinicians could have their performance categories reweighted without having to go through the application process.
CMS won't waive the application requirement for groups. This automated reweighting would only be applied to individuals; if you are reporting as part of a group, your group would have to apply for the reweighting.
How do you know if individuals in your area are eligible for automatic reweighting? CMS will post a fact sheet on the 2023 MIPS automatic extreme and uncontrollable circumstances policy, and it will list counties for which the automatic exception applies. In 2022, CMS first published this fact sheet in May and updated it each time new counties were added. You will find this fact sheet in the Resource Library at https://qpp.cms.gov.
Note: Suppose you are in a disaster zone and the end of the year is approaching, but your area hasn’t yet been flagged as eligible for an automatic exemption. Consider applying for an “extreme and uncontrollable circumstances” reweighting before you miss the Jan. 2, 2024 application deadline.
How performance categories are reweighted. If CMS approves your application to reweight one or more performance categories to zero, the weight(s) would be reallocated as shown in “Table: How the Performance Categories Are Weighted,” above.
IMPORTANT: Don’t submit data to CMS on performance categories that are accepted for reweighting. CMS will not reweight a performance category if you report data for it.
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