decisionhealth Newsletters, Part B News - 2017 Issue 11 (November)
Virtual groups on for 2018 – but providers have short lead time to sign up
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Article Overview
This article covers CMS’s final guidance on virtual groups under the Quality Payment Program and how the approach affects MIPS participation for solo practitioners and small practices. It is relevant to clinicians, practice managers, and coding/compliance staff who need to understand enrollment steps, group reporting mechanics, related reporting systems, and timing issues for the first year of the program. The discussion also highlights administrative requirements, participation considerations, and operational challenges identified by CMS and commenters.
Why This Topic Matters
Virtual groups create a new way for eligible practices to report under MIPS, so understanding the final policy and the short election timeline is important for practices deciding whether to participate and for organizations supporting MIPS reporting.
Article Sections
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Quality Payment Program: Virtual groups
Overview of the virtual group concept under the Quality Payment Program and its role in MIPS reporting for eligible practices.
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How virtuals are like regular groups
Discussion of how virtual groups align with broader group reporting concepts, including participation and performance-category considerations.
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How CMS assesses virtual groups
Summary of how CMS applies virtual group performance assessment and payment adjustments at the reporting and participant level.
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How to elect to be in a virtual group
Description of the election process, formal agreement requirements, submission timing, and reporting identifiers used by the group.
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Problems remain
Highlights of implementation concerns, administrative burdens, and unresolved operational issues raised about the first reporting year.
What You Will Learn
- How CMS structured virtual groups within the Quality Payment Program
- What types of practices may participate in a virtual group
- How virtual group reporting is organized at a high level
- What the election and agreement process involves
- Which operational challenges were identified for the first reporting year
Who Should Read This
- Physicians and solo practitioners
- Small practice groups
- Practice administrators
- MIPS reporting staff
- Compliance and revenue cycle professionals
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