There was a night before MIPSmas.

Before we finish up MIPS 2022 for the year, let me share with you a warning tale. You must pay close attention or you risk being put on CMS’s naughty list despite having been good all year.

This is a story of miscommunication and disinformation involving two problems:

• Due to the EHR’s failure to resolve a problem with its Patient Portal, I must make a claim for the Extreme and Uncontrollable Circumstances Exception (EUC).
• the idea that submitting the EUC Exception just once will permanently protect the providers.

Is Your EHR Nice or Naughty?

It appears that several 2015 Edition Certified EHRs are not upholding their responsibility to keep their conditions of certification maintenance current. Maintaining the functionality that enables their providers to successfully document the MIPS Promoting Interoperability (PI) measures using their EHR in particular. To allow their customers to claim that they are documenting patient encounters for MIPS Promoting Interoperability Category using a 2015 Edition Certified EHR, an EHR must be certified or include a certified third-party module.

The following functions are necessary:

• Sending prescriptions electronically is known as e-Prescribing.
• using the Direct Protocol, being able to create a C-CDA and send/receive an encounter summary.
• the usage of a third-party app to access a patient’s encounter data via an API, the ability to invite patients and/or their authorized representative to a protected patient portal, or both (Patient Engagement)

the capacity to record patient information exchanges across Public Health organizations

With the exception of inviting the patient and/or their authorized representative to a patient portal or using an API, providers can claim exclusions owing to low usage in a reporting period (minimum of any consecutive 90-days).

No exception applies to the “Provide Patients Electronic Access measure,” and if it is not reported, the entire PI category will receive a score of 0, regardless of how well the other PI measures performed.

Lack of Functionality in EHRs.

Some EHRs are no longer able to accurately record the appropriate provider actions that serve as documentation that these providers have complied with the Provide Patient Access metric due to flawed programming logic (Invited by email). Some EHRs advise providers to reject the PI category without disclosing that doing so may prevent them from submitting PI and IA and possibly earning a score in the excellent performer range (85 to 100).

EUC Exceptions only last for one performance year.

The second problem is that providers are receiving advice from EHRs on how to request the EUC exception and are being led to believe that once they do so, their request would be granted forever. Contrary to popular belief, the EUC exemption position needs to be reviewed annually. In some years, providers must submit a request form, while in others, if they meet specific requirements, it may be applied automatically. If a Practice is not paying attention, they risk receiving a (-9) % penalty for their inaction.

IMPORTANT WARNING:

For MIPS 2022, 75 points are now required to avoid a penalty. We urge you to think carefully before deciding to give the Quality category more weight than the PI category. Consider the scoring potential of the Quality indicators that your Practice will report on before deciding to reweight. The reweighted score may not be enough for your Practice to avoid a penalty or even qualify for incentives due to the updated Quality Measure Benchmarks.

How Providers Can Continue to Be Nice

Control both your reputation and your MIPS score.

Before doing anything else, get in touch with your EHR to find out how they intend to fix any issues that are preventing you from submitting your MIPS data and when they anticipate doing so.

• If you are not pleased with their response, you can contact the testing and certification organization that granted the EHR certification.

• You can get in touch with ONC if the Testing/Certification body doesn’t react (extremely unlikely).

My MPs Score can assist you. We are always available to assist you in completing MIPS and other CMS-mandated initiatives. If your practice is using a 2015 Edition Certified EHR, our MIPS White Glove Service is meant to offer insights on how to use unusual circumstances permitted by CMS for your Practice to b