The hardship exception applications for the Promoting Interoperability (PI) performance category and the Extreme and Uncontrollable Circumstances are now available on the Quality
Payment Program (QPP) website (

Promoting Interoperability Hardship Exception

To be considered for the PI exception, you must select one of the following specified reasons for review and approval:
• You are a MIPS-eligible clinician in a small practice
• You are a MIPS-eligible clinician using decertified EHR technology
• You have insufficient Internet connectivity
• Other extreme and uncontrollable circumstances
• Lack of control over the availability of Certified Electronic Health Record Technology (CEHRT)

If your application for the PI hardship exception is approved, you will not be required to submit data for the PI category. Instead, the 25% original weighting of the Promoting Interoperability category will be reallocated to the Quality performance category, making the Quality category worth 75% of your final MIPS score.

Extreme and Uncontrollable Circumstances Hardship Exception

To qualify for the Extreme and Uncontrollable Circumstances exception, you must indicate in your application the circumstances that affected your ability to collect and submit data. CMS defines extreme and uncontrollable circumstances as “rare events (highly unlikely to occur in a given year) entirely out-side your control and the facility in which you practice.” For more information on both exceptions and links to applications, see the following link:

Both hardship applications must be submitted by December 31, 2018. For more information, see the 2018 Hardship Exceptions Frequently Asked Questions located on the QPP website at