MIPS News for the Current Performance Year That Pathologists Need to Know

June 16, 2021

CMS has announced two items of interest that providers should be aware of for 2021.  

First, MIPS-eligible providers who are finding it difficult to meet MIPS program requirements due to COVID-19 may complete the MIPS Extreme and Uncontrollable Circumstances (EUC) Exception Application to request any or all performance categories be reweighted to 0%.  The application requires practices to complete an Event Description where they detail how the health crisis has impeded their participation in the MIPS program such as:

  • Being unable to collect information/data required for a MIPS category
  • Being unable to submit information/data for an extended period of time that is used for scoring a performance category
  • Impacting normal processes that could affect performance on cost or administrative claims measures

Most practices will remember that for the 2020 performance year, the EUC automatically applied to most practices.  So far for 2021, it is by application only – unless a practice is in a FEMA-designated area.   Supporting documentation does not have to be submitted with the application but does need to be made available for providers who are chosen by CMS for a data validation audit.

See the link below for further information.  Once there, choose Performance Year 2021 and select the Extreme and Uncontrollable Circumstances Exception link 


The second item concerns corrections CMS just made to the benchmark deciles used for scoring MIPS quality measures.  For each measure, historical benchmarks are assigned to deciles between 3 and 10, with corresponding ranges of performance rates.  Deciles allow providers to earn points and fractions of a point depending on where their scores fall within a decile.  For example, a measure scoring in the 7th decile can earn anywhere from 7 to 7.9 points, scores in the 8th decile can earn from 8 to 8.9 points, and so on up to a limit of 10 points for the 10th decile.  

  • A reminder:  Measures demonstrating consistently high performance rates with little variability are “Topped-Out” by CMS where they are subject to a process for possible future removal from the program.  In the meantime, their maximum points are capped at 7.  
  • This is important to anatomic pathologists as all measures in the pathology measure set are topped-out and, therefore, capped at 7 points.

In its recent notification, CMS indicated an error had been made in determining the 2021 benchmark values that were posted earlier this year.  The correction shifted all benchmarks down one decile from what was previously published.  This means if a performance rate previously fell in Decile 5 (worth 5 – 5.9 points), it’s now in Decile 4 where it can earn 4 – 4.9 points.  According to CMS, this error and subsequent ‘fix’ affected every quality measure in the benchmark file.

Let’s look at how the 2021 scoring looks for anatomic pathologists with what we know today:

The following five measures are ‘topped-out’ and capped at 7 points.  Performance rates of 100% earn 7 points.  Performance rates below 100% but more than 0% earn 3 points.

  • Barrett’s Esophagus (measure 249)
  • Radical Prostatectomy Pathology Reporting (measure 250)
  • Lung Cancer – Biopsy/Cytology Specimens (measures 395)
  • Lung Cancer – Resection Specimens (measure 396)
  • Melanoma Reporting (measures 397)

Measure 440 (Skin Cancer: Biopsy Reporting Time – Pathologist to Clinician) is ‘topped-out’ and capped at 7 points.  

  • Scores of 100% earn 7 points
  • Scores of 99.72 – 99.99:  4 – 4.9 points (Decile 4)
  • Scores of 98.36 – 99.71:  3 – 3.9 points (Decile 3)
  • Scores below Decile 3 but more than 0:  3 points

The updated 2021 Quality Measure Benchmark file can be found using the below link:

Benchmarks can vary based on the mechanism used for submitting MIPS quality data to CMS.  Choose Collection TypeMIPS CQM (column C) if you use a registry or QCDR to submit your data to the program.

In Conclusion
Naturally, the evolution of MIPS continues to present challenges and opportunities for those who can effectively leverage the incentive system to increase performance and achieve higher reimbursement. APS will continue to monitor the developments in MIPS reporting and threshold requirements. 

MIPS Pathology 2021 (169.21 KB)