Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.


CMS Quality Programs Bi-Monthly Forum – Tomorrow!
When: Tuesday, January 17, 2023  1:00 – 2:00 pm ET
Register for this event.

During this webinar, attendees will learn important updates relevant to CMS’s Quality Measurement and Value-Based Incentives Group (QMVIG). The forum will also provide stakeholders with the opportunity to ask CMS subject matter experts questions on quality reporting programs and initiatives that directly impact their organizations.

The forum will include updates on the following topics:

  • Updated 2023 CMS QRDA III Implementation Guide for Eligible Clinician Programs Following Publication of the CY 2023 Physical Fee Schedule Final Rule;
  • Quality Data Implementation (QDI) User Group;
  • Updated EC and EH/CAH eCQM Measure Files;
  • The Medicare Promoting Interoperability Program;
  • The Merit-based Incentive Payment System; and
  • Alternative Payment Model Updates.

Administrative Simplification Listening Session
When: Wednesday, January 25, 2023  2:00 – 3:30 pm ET
Register for this event.

Administrative Simplification Listening Session on Adoption of Standards for Health Care Attachment Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Standard Proposed Rule (CMS-0053-P) – CMS National Standards Group invites you to register for a listening session about the Adoption of Standards for Health Care Attachment Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Standard proposed rule that was published on December 21st. A second listening session will also be held on February 8th for those unable to attend.

The listening session will provide a public forum for CMS to hear feedback on the proposed rule. The call will cover the following topics:

  • Background on the current standards
  • What the proposed rule would do
  • How to submit comments on the proposed rule

They encourage participants to ask questions during the question-and-answer session at the end of the listening session.

Eligible Clinician eCQM Education & Outreach: Measure Specific Webinar
When: Thursday, February 2, 2023  3:00 pm ET
Register for this event.

The webinar will illuminate audience’s on CMS’s efforts to enhance the quality of the published 2023 performance period Eligible Clinician eCQMs. Goals of this webinar include increasing measure-specific education and outreach through the identification and exemplification of specific 2023 clinician-level eCQM update themes, including a careful review of eCQM global changes, eCQMs that underwent significant changes from performance period 2022 to 2023, and review of the new Eligible Clinician eCQM- CMS951v1- Kidney Health Evaluation. In addition, this webinar will serve to promote published resources, both their availability and effective utilization, located on the eCQI Resource Center.


CMS Extends the MIPS Extreme and Uncontrollable Circumstances Application Deadline for the 2022 MIPS Performance Year until March 3, 2023
For the 2022 performance year, they continue to use their Merit-based Incentive Payment System Extreme and Uncontrollable Circumstances application to allow clinicians, groups, virtual groups, and Alternate Payment Model Entities to request reweighting of MIPS performance categories due to the COVID-19 public health emergency.

They’ve extended the MIPS EUC application deadline for only individuals, groups, virtual groups, and APM Entities citing COVID-19 as the triggering event through 8 p.m. ET on Friday, March 3, 2023. Please note that applications received between January 3, 2023 and March 3, 2023 won’t override submitted data for individuals, groups, and virtual groups.

MIPS 2022 Data Submission Period is Now Open
CMS has opened the data submission period for MIPS eligible clinicians who participated in the 2022 performance year of the Quality Payment Program. Data can be submitted and updated until 8:00 p.m. ET on March 31, 2023.

How to Submit Your 2022 MIPS Data
Clinicians will follow the steps outlined below to submit their data:

  • Go to the Quality Payment Program sign in page.
  • Sign in using your QPP access credentials (see below for directions).
  • Submit your MIPS data for the 2022 performance year or review the data reported on your behalf by a third party. (You can’t correct errors with your data after the submission period, so it’s important to make sure the data submitted on your behalf is accurate.)

2022 MIPS Quality Measures Impacted by ICD-10 Coding Updates Effective October 1, 2022
In the calendar year 2022 Quality Payment Program final rule (85 FR 84898 through 84900), CMS finalized a process to stabilize measure data throughout the performance period when a measure is impacted by International Classification of Diseases, Tenth Revision (ICD-10) updates mid-performance period. ICD-10 code updates are effective annually on October 1, but quality measure specifications cannot be updated until the next MIPS program year. This annual review process was established to analyze and assess the quality measures to evaluate which measures are significantly impacted by the ICD-10 code updates. During this process, CMS identifies quality measures that meet the standard of 10% or more ICD-10 code changes and notifies MIPS participants of the impacted MIPS quality measures.

2023 MIPS Payment Adjustments in Effect Based on 2021 Performance
In August 2022, each MIPS eligible clinician received a 2021 MIPS final score and associated payment adjustment factor(s) as part of their 2021 MIPS performance feedback, available on the Quality Payment Program website.


The Deadline to Submit Your CY 2022 Medicare Promoting Interoperability Program Data is February 28, 2023
The deadline to register and submit your calendar year (CY) 2022 electronic health record (EHR) data for the Centers for Medicare & Medicaid Services (CMS) Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals (CAHs) is February 28, 2023 at 11:59 p.m. ET.

Program participants are required to submit through the CMS Hospital Quality Reporting (HQR) System (previously the QualityNet Secure Portal). Please reference the HQR User Guide for further details.

Quality Payment Program

Administrative Simplification

CMS Innovation Center