CMS is granting hardship exemptions on a case-by-case basis due to COVID-19. It is therefore possible for clinicians or groups to request to be exempted from all four performance categories in 2020. If clinicians submit a hardship exemption application and their application is approved, they will be held harmless from a payment adjustment due to that category in 2022—meaning that they will not be eligible for a bonus and not face a penalty based on their MIPS performance in 2020. Importantly, the Final Rule published a continuation of the hardship exemption process for 2021.

Performance Threshold: CMS has set the threshold that clinicians need to achieve to avoid a penalty in 2021 at 60 points. In the proposed rule, CMS had stated that the performance threshold would be 50 points in 2021, but CMS is now instituting a higher threshold.

MIPS Value Pathways (MVPs): CMS is committed to developing MVPs that would combine all four categories of MIPS reporting into a single more harmonized process. However, due to COVID-19, the implementation of MVPs is being delayed until 2022. ACEP is working with CMS on developing an MVP for emergency medicine and is examining how ACEP’s Qualified Clinical Data Registry, the Clinical Emergency Data Registry (CEDR), can help emergency physicians participate in an MVP.

2021 ED Facility Payments

CMS is increasing the Hospital Outpatient Prospective Payment System (OPPS) rate by 2.4 percent for 2021. Payments for the ambulatory payment classifications (APCs) related to the five ED E/M codes and critical care appear in Table 4.

Table 4: OPPS Rates for ED E/M Codes

Dr. Granovsky is president of LogixHealth, an ED coding and billing company, and currently serves as the course director of ACEP’s Coding and Reimbursement courses. He may be reached at mgranovsky@logixhealth.com.
Mr. McKenzie is ACEP’s reimbursement director and can be reached at dmckenzie@acep.org.