Virtual Groups Election Period for MIPS 2020 Performance Period Now Open

If you’re interested in forming a virtual group for the 2020 Merit-based Incentive Payment System (MIPS) performance year, the election period starts today. To form a virtual group, you must follow an election process and submit your election to CMS via email between October 1, 2019 and December 31, 2019. Details about virtual groups and the election process are available in this toolkit.

What is a Virtual Group?

A virtual group is a combination of two or more Taxpayer Identification Numbers (TINs) assigned to:

One or more solo practitioners (who are MIPS eligible clinicians); or
One or more groups consisting of 10 or fewer clinicians (including at least 1 MIPS eligible clinician); or
Both (solo practitioners and groups of 10 or fewer clinicians) that elect to form a virtual group for a performance period for a year

Note: A solo practitioner or group can only participate in one virtual group during the performance period.

What is the Election Process?

There is a two-stage election process for forming a virtual group:

Stage 1 (optional)

Contact your Quality Payment Program Technical Assistance organization for information regarding TIN size to help you determine if you meet the TIN size criteria to join or form a virtual group.

Stage 2 (required)

As part of Stage 2 of the election process, you must:

Have a formal written agreement
Name an official virtual group representative
Submit the virtual group’s election via e-mail to CMS at MIPS_VirtualGroups@cms.hhs.gov by December 31, 2019
Determine group size and low-volume threshold

Download the 2020 Virtual Groups Toolkit to learn more about the election process and how to participate in MIPS as a virtual group in 2020.

Need Help?

Request technical assistance from on-the-ground organizations that can provide no-cost support.

Contact the Quality Payment Program by:
- Email: QPP@cms.hhs.gov or
- Phone: 1-866-288-8292/ TTY: 1-877-715-6222

2019 MIPS Quality Measures Impacted by ICD-10 Updates Effective October 1, 2019

What is the Policy for Identifying Impacted Quality Measures?

In the calendar year (CY) 2018 Quality Payment Program final rule (82 FR 53716), CMS finalized a process to stabilize measure data throughout the performance period when a measure is impacted by ICD-10 updates mid-performance period. ICD-10 code updates are effective annually on October 1st, but quality measure specifications cannot be updated until the next MIPS program year. An annual review process was established to analyze and assess the quality measures to determine which measures are significantly impacted (determined by a 10% threshold) by ICD–10 code changes during the performance period.

CMS determines if a quality measure is significantly impacted by ICD-10 code updates by comparing the posted 2019 measure specifications with the ICD-10 codes that were deleted or added during the annual ICD-10 code updates, which will occur on October 1st of the performance period. If a quality measure is impacted by 10% or more ICD-10 code changes, the performance period and subsequent performance score for the affected quality measure will be based only on the first 9 months of the 12-month performance period. The criteria to suppress performance data includes:

Greater than 10% code changes in the measure numerator, denominator, exclusions, and exceptions
Clinical guideline changes, new products, or procedures reflected in ICD–10 code changes
Feedback on a measure received from measure developers and stewards

Which Quality Measures are Impacted for the 2019 Performance Period?

CMS has identified the following quality measures requiring performance data to be suppressed for the last quarter of the performance period. Performance data would be limited to the first nine months (Jan 1 – Sep 30) of the performance period:

Quality Number	Measure Title	Primary Measure Steward	Data Collection Type
326	Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy	American College of Cardiology	Medicare Part B Claims, MIPS CQM
392	HRS-12: Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation Ablation	American College of Cardiology Foundation	MIPS CQM

Where Do I Go for Assistance?

If you have questions regarding the ICD-10 impact analysis, please direct them to the Quality Payment Program for timely assistance. You can reach the Quality Payment Program Service Center by:

Email: qpp@cms.hhs.gov
Phone: 1-866-288-8292
TTY: 1-877-715-6222