Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Excep

Merit-based Incentive
Payment System (MIPS)
2023 Extreme and Uncontrollable
Circumstances Exception
Application Guide

Table of Contents

Already know what MIPS is?
Skip ahead by clicking the links in the Table of Contents.

How To Use This Guide

3

Overview

5

Frequently Asked Questions

14

Application Steps

18

Help and Version History

31

Appendices

34

Purpose: This guide will provide general information about the Extreme and Uncontrollable
Circumstances (EUC) Exception application and provide step-by-step instructions on how to complete
the application.

2

How to Use This Guide

How to Use This Guide

Table of Contents
The Table of Contents is interactive. Click on a Chapter
in the Table of Contents to read that section.
You can also click on the icon on the
bottom left to go back to the Table of
Contents.

Please Note: This guide was prepared for informational
purposes only and isn’t intended to grant rights or
impose obligations. The information provided is only
intended to be a general summary. It isn’t intended to
take the place of the written law, including the
regulations. We encourage readers to review the specific
statutes, regulations, and other interpretive materials for
a full and accurate statement of their contents.

Hyperlinks
Hyperlinks to the Quality Payment Program website are
included throughout the guide to direct the reader to
more information and resources.

4

MIPS Extreme and
Uncontrollable Circumstances
Exception Application
Overview

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Overview
We understand that there may be circumstances out of your control that make it difficult for you to meet program
requirements. To reduce this burden, we provide an opportunity for qualifying clinicians, groups, virtual groups and
Alternative Payment Model (APM) Entities to apply for performance category reweighting for MIPS.
What

Who

Why

The MIPS Extreme and Uncontrollable Circumstances (EUC) Exception application allows you to request reweighting for one or more
performance categories to 0%.
See Appendix A1, Appendix A2, and Appendix B for more information on performance category reweighting in traditional MIPS, MIPS Value
Pathways (MVPs) and the APM Performance Pathway (APP).
Individual clinicians, groups, virtual groups, and APM Entities
• Third party intermediaries can submit an application with permission from the clinician or practice.
Subgroups registered to report an MVP can request reweighting through the QPP Service Center; subgroup reweighting requests will be
superseded by any reweighting approved for their affiliated group. See Slide 11 for additional information.
You can submit an application to have your MIPS quality, cost, improvement activities, and/or Promoting Interoperability performance
categories reweighted to 0% if:
• You experience an extreme and uncontrollable circumstance outside of your control, such as a natural disaster, ransomware attack or
public health emergency (PHE), that prevents you from collecting data for an extended period of time, or that could impact your
performance on cost measures.
Note: APM Entities are required to request reweighting for all performance categories.

When

The MIPS EUC Exception application will close at 8 p.m. ET on January 2, 2024.
Sign in to the Quality Payment Program (QPP) website with your HCQIS Access and Roles Profile (HARP) account.

Where

How

You must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application. For more information on
HARP accounts, please refer to the Register for a HARP Account document in the QPP Access User Guide (ZIP).
Note: APM Entity representatives must have the Security Official role in order to complete the Extreme and Uncontrollable Circumstances
Exception application on behalf of their entity. Refer to the Connect to an Organization document in the QPP Access User Guide (ZIP) for more
information on requesting the Security Official role.
1. Register for a HARP account
2. Sign in to the QPP website
3. Select ‘Exceptions Applications’ on the left-hand navigation
4. Select ‘Add New Exception’
5. Select ‘Extreme and Uncontrollable Circumstances Exception’
6. Complete the application for individual, group, virtual group, or APM Entity participation
6

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Policies for Individual Clinicians, Groups, and Virtual Groups
MIPS EUC Exception applications can be
submitted for one or more performance
categories. Any data you submit, or is submitted
on your behalf, will override reweighting for that
performance category and the category will be
scored.
• If you later determine that you’re able to collect
data for a performance category approved in your
application, you can submit that data and it will
be scored.
• If the cost performance category is included in
the application, cost measures won’t be scored
even if data is submitted for other performance
categories.
• If you submit Medicare Part B Claims measures
during the performance year, this will override
quality performance category reweighting.
However, if you request and are approved for
reweighting in all 4 performance categories and
don’t submit data for another performance
category, your MIPS final score for the 2023 MIPS
performance period would be equal to the
performance threshold and you would receive a
neutral payment adjustment in 2025.

You must be scored on at least 2 performance
categories to earn a MIPS final score other than the
performance threshold.

When fewer than 2 performance categories can be
scored (meaning 1 performance category is weighted at
100% of your MIPS final score, and the other
performance categories are weighted at 0%), the MIPS
final score for the 2023 MIPS performance period would
be equal to the performance threshold and you would
receive a neutral payment adjustment in 2025.
You’ll be scored in any performance category that’s not included in
your application, unless you qualify for reweighting through
another policy.
For example:
• If you don’t meet the case minimum for any cost measures, the
cost performance category will be reweighted.
• You qualify for reweighting under the automatic Extreme and
Controllable Circumstances policy.
o Review the 2023 Automatic Extreme and Uncontrollable
Circumstances Fact Sheet (PDF) for additional
information.
• Certain clinician types and individuals, groups, and virtual groups
with certain special statuses qualify for automatic reweighting of
the Promoting Interoperability performance category.
o For additional information on automatic reweighting of
Promoting Interoperability, review the 2023 Promoting
Interoperability Quick Start Guide (PDF).
7

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Intersection Between the Automatic MIPS EUC Policy and the Application-Based
MIPS EUC Policy
If you qualify for reweighting under the automatic MIPS EUC policy, then we’ll reweight all 4 performance
categories to 0% (rather than just the categories included in your MIPS EUC Exception application). We’ll score any
performance category for which data is submitted.
Example
Scenario

A MIPS eligible clinician who is eligible for
the automatic MIPS EUC policy has also
submitted an MIPS EUC Exception
application. The application was approved
for reweighting in the Promoting
Interoperability performance category,
and the clinician submits data for the
quality and improvement activities
performance categories.

Outcome
You’ll be scored as follows:
• The quality and improvement activities performance
categories will be scored because you submitted data for
those categories
• The cost performance category is reweighted to 0% under
the automatic EUC policy.
• The Promoting Interoperability performance category is also
reweighted to 0% under the automatic EUC policy.
Note, in this example, the MIPS EUC Exception application
wasn’t needed to reweight the Promoting Interoperability
performance category due to the automatic MIPS EUC policy.

8

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Individual Clinicians, Groups, and Virtual Groups Reporting Traditional MIPS /
Individual Clinicians and Groups Reporting an MVP
If you qualify for reweighting under the automatic MIPS EUC policy, then we’ll reweight all 4 performance
categories to 0% (rather than just the categories included in your MIPS EUC Exception application). We’ll score any
performance category for which data is submitted.
Example
Scenario

Outcome
You’ll receive a MIPS final score based on the data submitted.

You’re planning to report traditional
MIPS or registered to report an MVP.
You submit an application to have all 4
performance categories reweighted, but
later determine you’re able to report the
improvement activities and Promoting
Interoperability performance categories.

• The improvement activities performance category will be
weighted at 15%.
• The Promoting Interoperability performance category will be
weighted at 85%.
• The quality performance category will retain a 0% weight
because you didn’t submit quality data.
• The cost performance category will retain a 0% weight
because there are no data submission requirements
associated with the cost performance category (reweighting
can’t be voided).

9

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Individual Clinicians and Groups Reporting the APP
Example
Scenario

Outcome
You’ll receive a MIPS final score based on the data submitted.

• The improvement activities performance category will be
You’re a MIPS eligible clinician (or group)
weighted to 25%.
planning to report the APP. You submit an • The Promoting Interoperability performance category will be
application to reweight the quality
weighted to 75%.
performance category and your
• The quality performance category will be weighted at 0%
application was approved.
provided no data is submitted.
• The cost performance category will retain a 0% weight
(because cost isn’t scored under the APP).

10

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Policies for Subgroups Reporting an MVP
Clinicians who register to report an MVP as a subgroup will inherit the performance category reweighting
approved for their affiliated group.
• Data submission by the affiliated group won’t override performance category reweighting for the subgroup.
• Data submission by the subgroup won’t override performance category reweighting for the affiliated group.
Clinicians who register to report an MVP as a subgroup can request performance category reweighting at
the subgroup level by contacting the QPP Service Center.
• Subgroups won’t be able to submit a MIPS EUC Exception application as outlined in this guide.
A subgroup’s request for reweighting will be superseded by any reweighting
approved for their affiliated group.

11

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Policies for APM Entities

APM Entities
APM Entities in the following models can submit an EUC Exception application on behalf of their
MIPS eligible clinicians:
•
•
•
•
•
•
•
•
•
•
•

Medicare Shared Saving Program
Vermont Medicare ACO Model
Bundled Payments for Care Improvement (BPCI) Advanced Model
Enhanced Oncology Model (EOM)
Maryland Total Cost of Care
Independence at Home Demonstration
Primary Care First (PCF)
Value in Opioid Use Disorder Treatment (ViT)
ACO Realizing Equity Access and Community Health (REACH) Model
Comprehensive Care for Joint Replacement (CJR) Payment
Kidney Care Choices (KCC)

12

MIPS Extreme and Uncontrollable Circumstances
Exception Application Overview
Policies for APM Entities (Continued)
APM Entity applications must be submitted for all performance categories.
• You can’t submit an application for an APM Entity to request reweighting in 1 or 2 performance categories.
• This is different from our policy for individual, group, and virtual group applications.
If your APM Entity’s application is approved, the APM Entity will receive a final score equal to the
performance threshold even if data are submitted for the APM Entity.
• The MIPS eligible clinicians in the APM Entity will receive a neutral MIPS payment adjustment unless they have a
higher final score from individual or group participation.
• Data submitted for an APM Entity will not override performance category reweighting from an approved
application.
• This is different from our policy for individual, group, and virtual group applications.
At least 75% of MIPS eligible clinicians in an APM Entity must qualify for reweighting of the Promoting
Interoperability performance category.
• Given that APM Entities are required to request reweighting for all performance categories in their EUC Exception
application, at least 75% of the MIPS eligible clinicians in the Entity will need to qualify for reweighting in the
Promoting Interoperability performance category.
• They may qualify automatically or by meeting one of the criteria for the MIPS Promoting Interoperability
Hardship Exception.
APM Entity representatives must have a QPP Security Official role to complete the Extreme and
Uncontrollable Circumstances Exception application on behalf of their entity.
• Review the Connect to an Organization resource in the QPP Access User Guide (ZIP) for more information on
obtaining the Security Official role.

An approved application won’t affect your model-specific reporting requirements.
• For example, Shared Savings Program ACOs must report the quality measures identified under the APP to meet
their requirements under the Shared Savings Program, unless otherwise excepted under that APM.

13

MIPS Extreme and
Uncontrollable Circumstances
Exception Application Process:
Frequently Asked Questions

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Frequently Asked
Questions
How Does CMS Assess MIPS EUC Exception Application Requests?
We consider the variables affecting your ability to
collect and submit data for each performance
category when reviewing your application for
performance category reweighting due to
extreme and uncontrollable circumstances.
During our review, we will review both the event
circumstances and the length of time you were
impacted as indicated in your application to
assess the ability of a MIPS eligible clinician to
submit data for each performance category
selected in the application.

Example:

The performance period for an improvement
activity is a continuous 90-day period (or as
specified in the activity description) whereas the
performance period for the quality performance
category is 12 months. An issue lasting 3 months
may have more impact on the availability of
measures for the quality performance category
than your ability to perform and attest to
improvement activities.

How Long Does it Take to Process an EUC Exception Application?
• The length of time it takes to process application requests depends on the volume of requests we receive. We
review all application requests in the order that they were received. Once a decision is made regarding your
application, you’ll receive a notice of our decision and the status of your application will be reflected in your QPP
Account on the QPP website.

Where Can I Look for a Status Update on My EUC Exception Application?
• You can monitor your application status in your QPP Account on the QPP website.

15

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Frequently Asked
Questions
Are We Required to Submit Documentation with Our EUC Exception Application?
• No, you aren’t required to submit documentation with your application.
• However, you should retain documentation of the circumstances supporting your application for your own
records in the event that you are selected by CMS for data validation or an audit. See our 2023 MIPS Data
Validation Criteria Guide (ZIP) for information on the data validation and audit process.

How Can I Correct a Mistake Made on Our EUC Exception Application?
• If you identified an error with your exception application, please contact the Quality Payment Program Service
Center by email at [email protected], create a QPP Service Center ticket, or by phone at 1-866-288-8292
(Monday-Friday, 8 a.m. - 8 p.m. ET).

Can Additional Staff Members Access/Receive Notifications About the Status of
Our EUC Exception Application?
• Yes, you can add additional staff or representatives who should receive notifications about the status of the
application.
• In the Additional Access section of the application, provide the email address(es) of additional staff or
representatives who would like to receive email notifications.
• Please note that the additional staff or representatives must have HARP credentials in order to see the
application on the QPP website.

Important Note: Corrections can’t be made after the application period has closed.

16

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Frequently Asked
Questions
Can we submit one MIPS EUC Exception application at the group level rather than
separate applications for each individually eligible clinician?
• Yes, you can submit a group-level application instead of separate applications for each clinician if the EUC applies
to the whole group. However, if the circumstances are specific to a subset of clinicians in the group, you’d need
to submit individual applications for each of those clinicians.

Our third party intermediary experienced issues and is unable to submit data on
our behalf. Can we submit an EUC Exception application for this issue?
• As noted in the Calendar Year 2018 Quality Payment Program Final Rule, extreme and uncontrollable
circumstances, such as natural disasters, may affect a clinician's ability to access or submit quality measures via all
submission mechanisms (effectively rendering the measures unavailable to the clinician), as well as the availability
of numerous improvement activities. In addition, damage to a facility where care is provided due to a natural
disaster, such as a hurricane, could result in practice management and clinical systems that are used for the
collection or submission of data to be down, thus impacting a clinician's ability to submit necessary information
via Qualified Registry, QCDR, CMS Web Interface, or claims.
• This policy doesn’t include issues that third party intermediaries, such as Electronic Health Record vendors
(EHRs), QCDRs, or Qualified Registries, might have submitting information to MIPS on behalf of a MIPS eligible
clinician.
• Instead, this policy is geared towards events, such as natural disasters, that affect the MIPS eligible clinician's
ability to submit data to the third party intermediary, which in turn, could affect the ability of the clinician (or the
third party intermediary acting on their behalf) to successfully submit measures and activities to MIPS.

17

MIPS Extreme and
Uncontrollable Circumstances
Exception Application Process:
Application Steps

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 1: Sign in to Your QPP Account
With your HARP credentials, sign in to your QPP
Account on the QPP website.

Note: If you haven’t signed in on the QPP
website before, you must register for an
account to obtain your HARP credentials.

*The screenshots included in this user guide were based on the
QPP test environment. Because we are always working to
incorporate feedback and improve the experience, there may
be differences between these screenshots and what you see on
the QPP website.
19

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 2: Navigate to Your
Exception Applications
Once you’re signed into your account,
select:​
• The Exception Application tab in
the left-hand navigation menu,
then click + Add New QPP
Exception

OR
• The Start an Application quick link
on the home page.

*The screenshots included in this user guide
were based on the QPP test environment.
Because we are always working to
incorporate feedback and improve the
experience, there may be differences
between these screenshots and what you
see on the QPP website.
20

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 3: Select Extreme and
Uncontrollable Circumstances Exception
Select the Extreme and Uncontrollable Circumstances
Exception, then click Continue.

*The screenshots included in this user guide were based on
the QPP test environment. Because we are always working to
incorporate feedback and improve the experience, there may
be differences between these screenshots and what you see
on the QPP website.

21

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 4: Select Application Type
Select the participation level at which you intend (or
intended) to participate in MIPS.

Note: If reporting an MVP with a
subgroup, you must contact the QPP
Service Center to request an Extreme and
Uncontrollable Circumstances Exception
application.

*The screenshots included in this user guide were based
on the QPP test environment. Because we are always
working to incorporate feedback and improve the
experience, there may be differences between these
screenshots and what you see on the QPP website.

22

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 5: Enter Participation Level Information
Enter the required participation level information.
The required information for each participation level is as follows:
Participation
Level
Individual
Clinician

Required Information
• National Provider Identifier
(NPI)
• Practice Affiliation

Group

• Taxpayer Identification
Number (TIN)

Virtual Group

• Virtual Group Identifier

APM Entity

• APM Entity ID

Note: If you’re an individual clinician, group,
or virtual group requesting reweighting of
only 1 or 2 MIPS performance categories and
intend to submit data for others, it is critical
that you select the application type that
aligns with the level at which you intend to
submit data to MIPS (i.e., at the individual,
group or virtual group level).

*The screenshots included in this user guide were based on the
QPP test environment. Because we are always working to
incorporate feedback and improve the experience, there may be
differences between these screenshots and what you see on the
QPP website.

23

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 6: Enter Submitter Details
Enter your contact information (as the
submitter) and identify your relationship
to the party identified in the application.

*The screenshots included in this user guide
were based on the QPP test environment.
Because we are always working to incorporate
feedback and improve the experience, there
may be differences between these screenshots
and what you see on the QPP website.

24

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 7: Enter Additional Staff in the Additional Access Section
You can identify additional users to receive notifications about the application in the Additional Access section.
If there’s a HARP account associated with the email address(es) you provide, the person will be able to sign in to
their QPP Account on the QPP website and access the application.

*The screenshots included in this user guide were based on the QPP test environment. Because we are always working to
incorporate feedback and improve the experience, there may be differences between these screenshots and what you see on
the QPP website.

25

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 8: Enter the Extreme and
Uncontrollable Circumstances
Event Type
Select the appropriate Event Type for
the extreme and uncontrollable
circumstance you experienced.
Then, enter the timeframe for which
you were impacted by the extreme
and uncontrollable event by
completing the Event Date Range. If
you continue to be impacted by the
event, select Event Still Persists.

*The screenshots included in this user guide
were based on the QPP test environment.
Because we are always working to incorporate
feedback and improve the experience, there
may be differences between these screenshots
and what you see on the QPP website.

26

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 9: Provide a Brief Description of the Challenges You Experienced
Provide a brief description about the data collection challenges that you experienced due to the extreme and
uncontrollable event and how your 2023 performance data will be impacted.

Note: You don’t need to submit supporting documentation with your application.
However, you should retain documentation of the circumstances supporting your application for your own
records in the event that you’re selected by CMS for data validation or an audit.
See our 2023 MIPS Data Validation Criteria for information on the data validation and audit process.
*The screenshots included in this user guide were based on the QPP test environment. Because we are always working to
incorporate feedback and improve the experience, there may be differences between these screenshots and what you see on
the QPP website.
27

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 10: Select MIPS Performance
Categories
Select each MIPS performance category
for which you’re requesting reweighting by
checking the corresponding box next to the
category name, then select Submit for
Review.

Note: All performance categories will be
automatically selected for APM Entity
applications.

*The screenshots included in this user guide were based on the QPP test environment. Because we are always working to
incorporate feedback and improve the experience, there may be differences between these screenshots and what you see on
the QPP website.
28

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Step 11: Submit Extreme and
Uncontrollable Circumstances
Application
Once you’re done with your application,
review the disclosures, then select the
Certify & Submit button.

*The screenshots included in this user guide were
based on the QPP test environment. Because we
are always working to incorporate feedback and
improve the experience, there may be differences
between these screenshots and what you see on
the QPP website.

29

MIPS Extreme and Uncontrollable Circumstances
Exception Application Process: Application Steps
Extreme and Uncontrollable Circumstances
Exception Application Submission
Confirmation
After you submit your application, you’ll
receive a message stating that your
application has been successfully submitted
and is pending review. You’ll also receive an
email notification.

*The screenshots included in this user guide were
based on the QPP test environment. Because we
are always working to incorporate feedback and
improve the experience, there may be differences
between these screenshots and what you see on
the QPP website.

30

Help and Version History

Help and Version History
Where Can You Go for Help?

Contact the Quality Payment
Program Service Center by email
at [email protected], create a
QPP Service Center ticket, or by
phone at 1-866-288-8292
(Monday through Friday,
8 a.m. - 8 p.m. ET).
• Customers who are hearing
impaired can dial 711 to be
connected to a TRS
Communications Assistant.

Visit the Quality Payment
Program website for other help
and support information, to learn
more about MIPS, and to check
out the resources available in the
Quality Payment Program
Resource Library.

32

Help and Version History
Version History
If we need to update this document, changes will be identified here.

Date
05/01/2023

Description
Original Posting.

33

Appendices

Appendices
Appendix A1.
2023 Performance Year MIPS Performance Category Weight Redistribution Policies
for Individual Clinicians, Groups, Virtual Groups, and APM Entities Reporting
Traditional MIPS or MVPs
The table below illustrates the 2023 performance
Refer to Appendix B for reweighting policies for
category weights and reweighting policies that CMS will
APM Entities reporting the APP. APM Entities
apply to clinicians, groups, and virtual groups reporting
reporting traditional MIPS can only request
traditional MIPS or MVPs. (Small practices should refer
reweighting for all performance categories.
to Appendix A2.)
If fewer than 2 performance categories can be scored (meaning 1 performance category is weighted at 100%, or all
performance categories are weighted at 0%), the clinician, group, or virtual group will receive a final score equal to
the performance threshold and the MIPS eligible clinicians will receive a neutral payment adjustment in the 2024
payment year.
MIPS Performance Category Reweighting
Scenario

Quality
Category
Weight

Cost
Category
Weight

Improvement
Activities
Category Weight

Promoting
Interoperability
Category Weight

30%

30%

15%

25%

55%

0%

15%

30%

45%

30%

0%

25%

55%

30%

15%

0%

0%

30%

15%

55%

No Reweighting

Standard Weighting under traditional MIPS
Reweight 1 Performance Category
No Cost
(Cost → Quality and Promoting Interoperability)
No Improvement Activities
(Improvement Activities → Quality)
No Promoting Interoperability
(Promoting Interoperability → Quality)
No Quality
(Quality → Promoting Interoperability)

Table continues on the following slide.
35

Appendices
Appendix A1.
2023 Performance Year MIPS Performance Category Weight Redistribution Policies
for Individual Clinicians, Groups, Virtual Groups, and APM Entities Reporting
Traditional MIPS or MVPs (Continued)
MIPS Performance Category Reweighting
Scenario

Quality
Category
Weight

Cost
Category
Weight

Improvement
Activities Category
Weight

Promoting
Interoperability
Category Weight

Reweight 2 Performance Categories
No Cost + No Promoting Interoperability
85%
0%
15%
0%
(Cost + Promoting Interoperability → Quality)
No Cost + No Quality
0%
0%
15%
85%
(Cost + Quality → Promoting Interoperability)
No Cost + No Improvement Activities
(Cost + Improvement Activities → Promoting
70%
0%
0%
30%
Interoperability + Quality)
No Promoting Interoperability + No Quality
(Promoting Interoperability + Quality → Cost +
0%
50%
50%
0%
Improvement Activities)
No Promoting Interoperability + No
Improvement Activities
70%
30%
0%
0%
(Promoting Interoperability + Improvement
Activities → Quality)
No Quality + No Improvement Activities
(Quality + Improvement Activities → Promoting
0%
30%
0%
70%
Interoperability)
Reweight 3 Performance Categories
If you have multiple performance categories reweighted to 0% so that a single performance category is weighted at 100% of
your final score, you’ll receive a score equal to the performance threshold regardless of any data submitted or not and receive
a neutral payment adjustment.
Reweight 4 Performance Categories
If all performance categories are reweighted to 0%, you’ll receive a score equal to the performance threshold regardless of any
data submitted or not and receive a neutral payment adjustment.
36

Appendices
Appendix A2.
MIPS Performance Category Weight Redistribution Policies Under Traditional MIPS
Finalized for the 2023 Performance Year: Small Practices
Refer to Appendix B for reweighting policies that
apply to APM Entities reporting the APP. APM Entities
reporting traditional MIPS or MVPs can only request
reweighting for all performance categories.

The table below illustrates the 2023
performance category weights and reweighting
policies that CMS will apply to small practices.
Quality
Category
Weight

Cost
Category
Weight

Improvement
Activities Category
Weight

Promoting
Interoperability
Category Weight

30%

30%

15%

25%

No Cost
(Cost → Quality and Promoting Interoperability)

55%

0%

15%

30%

No Improvement Activities
(Improvement Activities → Quality)

45%

30%

0%

25%

No Promoting Interoperability
(Promoting Interoperability → Quality and
Improvement Activities)

40%

30%

30%

0%

No Quality
(Quality → Promoting Interoperability)

0%

30%

15%

55%

MIPS Performance Category Reweighting
Scenario

No Reweighting
Standard Weighting under traditional MIPS for
small practices

Reweight 1 Performance Category

Table continues on the following slide.
37

Appendices
Appendix A2.
MIPS Performance Category Weight Redistribution Policies Under Traditional MIPS
Finalized for the 2023 Performance Year: Small Practices (Continued)
MIPS Performance Category Reweighting
Scenario
Reweight 2 Performance Categories
No Cost + No Promoting Interoperability
(Cost + Promoting Interoperability → Quality
and Improvement Activities)
No Cost + No Quality
(Cost + Quality → Promoting Interoperability)
No Cost + No Improvement Activities
(Cost + Improvement Activities → Promoting
Interoperability + Quality)
No Promoting Interoperability + No Quality
(Promoting Interoperability + Quality → Cost +
Improvement Activities)
No Promoting Interoperability + No
Improvement Activities
(Promoting Interoperability + Improvement
Activities → Quality)
No Quality + No Improvement Activities
(Quality + Improvement Activities → Promoting
Interoperability)

Quality
Category
Weight

Cost
Category
Weight

Improvement
Activities
Category
Weight

Promoting
Interoperability
Category Weight

50%

0%

50%

0%

0%

0%

15%

85%

70%

0%

0%

30%

0%

50%

50%

0%

70%

30%

0%

0%

0%

30%

0%

70%

Note: If you have multiple performance categories reweighted to 0% so that a single performance category is
weighted at 100% of your final score, you’ll receive a score equal to the performance threshold regardless of any
data submitted or not submitted. See next slide for additional information.
38

Appendices
Appendix B.
2023 Performance Year MIPS Performance Category Weight Redistribution Policies
for APM Entities and APM Participants Reporting the APP
The table below illustrates the 2023 performance category weights and reweighting policies
that CMS will apply to APM Entities reporting traditional MIPS or MVPs and to individual
clinicians, groups and APM Entities reporting via the APP.

Reminder: APM Entities
can only submit an EUC
Exception Application for
all performance categories.

Reminders:
• Cost isn’t scored under the APP.
• There are no reporting requirements for the improvement activities performance category under the APP for the 2023
performance year. Participants reporting via the APP will automatically receive full credit for the improvement activities
performance category.
• Participants reporting via the APP will follow the same reporting requirements as traditional MIPS for the Promoting
Interoperability performance category.
MIPS Performance Category Reweighting
Scenario

Quality
Category
Weight

Cost
Category
Weight

Improvement
Activities
Category
Weight

Promoting
Interoperability
Category Weight

No Reweighting
Standard Weighting under the APP
50%
0%
20%
30%
Reweight 1 Performance Category
No Promoting Interoperability
75%
0%
25%
0%
(Promoting Interoperability → Quality)
No Quality
0%
0%
25%
75%
(Quality → Promoting Interoperability)
Reweight 2+ Performance Categories
If you have multiple performance categories reweighted to 0% so that a single performance category is weighted at 100% of
your final score, you’ll receive a score equal to the performance threshold regardless of any data submitted or not and receive
a neutral payment adjustment.
39

Appendices
Appendix C.
MIPS Promoting Interoperability Hardship Exception Application Status
Descriptions
The table below provides a description of each application status in the order of which they occur.

Draft in Progress

Submitted – Pending
Approval

You’re currently working
on your application and
haven’t submitted it yet.

You’ve successfully
completed and submitted
your application.

Select Manage to continue
working on your
application.

Applications are reviewed
in the order of which
they’re received.

Approved / Denied

We completed our review
of your application and
approved your request.

We completed our review
of your application and
denied your request.

Withdrawn

You’ve withdrawn your
application. You can
withdraw your application
at any point in the process.
An application can’t be
reopened after being
withdrawn. You’ll need to
complete a new
application.

40