วิวินาวิ : วอชิงตันดีซี : (สหรัฐอเมริกา) Washington DC

Centers for Medicare & Medicaid Services Quality Payment Program
* 2025 Merit-based Incentive Payment System (MIPS) Performance Year Virtual Group Election Period [ #link_1 ]
* Reminder: 2023 Targeted Review Available [ #link_2 ]

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2025 Merit-based Incentive Payment System (MIPS) Performance Year Virtual Group Election Period

If you’re interested in forming a virtual group for the 2025 MIPS performance year [ https://qpp.cms.gov/mips/virtual-group-participation ], the election period will begin on October 1, 2024. To form a virtual group, an election must be submitted to CMS via email at MIPS_VirtualGroups@cms.hhs.gov between *October 1, 2024, *and *December 31, 2024* *(11:59 p.m. ET)*. 

*Is a Virtual Group Required to Submit an Election to Participate in MIPS for the 2025 MIPS Performance Year? * 

Yes, a virtual group must submit an election to CMS for each performance year it intends to participate in MIPS as a virtual group. Refer to [ https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-414/subpart-O/section-414.1315 ]*§ 414.1315* [ https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-414/subpart-O/section-414.1315 ]. 

If your virtual group was approved for the 2024 MIPS performance year and intends to participate in MIPS as a virtual group for the 2025 MIPS performance year, your virtual group must still submit an election to CMS for the 2025 MIPS performance year between *October 1, 2024*, and *December 31, 2024 (11:59 p.m. ET).*   

*What is a Virtual Group? * 

A virtual group is a combination of 2 or more Taxpayer Identification Numbers (TINs) consisting of: 


* Solo practitioners (defined as the only clinician in a practice) who are MIPS eligible [ https://qpp.cms.gov/mips/how-eligibility-is-determined ]; and/or 

* Groups that have 10 or fewer clinicians (at least one clinician within the group must be MIPS eligible). A group is considered to be an entire single TIN. 

A virtual group has the flexibility to determine its own makeup. 

A solo practitioner or group can only participate in one virtual group during the performance year. 

*How Can I Benefit from Participating in a Virtual Group?* 

*You can:  * 


* Collaborate, share resources, and potentially increase your performance under MIPS. 

* Increase performance volume so you can be reliably measured. 

*What is the Virtual Group Election Process?* 

A virtual group must do the following prior to submitting an election: 


* Establish a formal written agreement between each TIN within the virtual group (see Agreement Sample Template in the 2025 MIPS Virtual Group Election Process Guide within the 2025 MIPS Virtual Group Toolkit (ZIP, 2MB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3009/2025-MIPS-Virtual-Group-Toolkit.zip ]). 

* Identify an official virtual group representative. 

The following elements must be included in an election: 


* Acknowledge that a formal written agreement has been established between each TIN within the virtual group. 

* The name and contact information for the official virtual group representative. 

* The name and TIN for each practice, and all associated National Provider Identifiers (NPIs) under each TIN. 

Once the above is complete, the virtual group must submit the election to CMS via email at MIPS_VirtualGroups@cms.hhs.gov by *11:59 p.m. ET on December 31, 2024* (see Election Email Sample in the 2025 MIPS Virtual Group Election Process Guide within the 2025 MIPS Virtual Group Toolkit (ZIP, 2MB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3009/2025-MIPS-Virtual-Group-Toolkit.zip ]). 

Please note that the 2025 MIPS Virtual Group Toolkit (ZIP, 2MB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3009/2025-MIPS-Virtual-Group-Toolkit.zip ] contains additional helpful information regarding virtual group participation in MIPS, virtual group reporting requirements, the election process, checklists for virtual groups to consider, and sample templates.

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Reminder: 2023 Targeted Review Available

Review your MIPS performance feedback, including your MIPS final score and payment adjustment factor(s), on the Quality Payment Program website [ https://qpp.cms.gov/login ]. 


* Individual clinicians, groups, subgroups, virtual groups, Alternative Payment Model (APM) Entities (including Shared Savings Program Accountable Care Organizations (ACOs)), designated support staff and authorized third party intermediaries may request that CMS review the calculation of their MIPS payment adjustment factor(s) through a process called targeted review. 

*When to Request a Targeted Review* 

If you believe there’s an error in the calculation of your MIPS payment adjustment factor(s), you can request a targeted review *now until October 11, 2024, at 8 p.m. ET*. 

For example: 


* Data were submitted under the wrong TIN or National Provider Identifier (NPI). 

* You have Qualifying APM Participant (QP) status and shouldn’t receive a MIPS payment adjustment. 

* Performance categories weren’t automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances. 

*Note: *This isn’t a comprehensive list of circumstances. If you have questions about whether your circumstances warrant a targeted review, please contact the QPP Service Center by phone at 1-866-288-8292 (Telecommunications Relay Services (TRS): 711) or by email at QPP@cms.hhs.gov.   

*How to Request a Targeted Review* 

You can access your MIPS final score and performance feedback and request a targeted review: 


* Sign in [ https://qpp.cms.gov/login ] using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) credentials (ACO-MS credentials for Shared Savings Program ACOs); these are the same credentials that allowed you to submit your 2023 MIPS data. 

* Click “Targeted Review” on the left-hand navigation. 

CMS generally requires documentation to support a targeted review request, which varies by circumstance. A CMS representative will contact you about providing any specific documentation required. If the targeted review request is approved and results in a scoring change, we’ll update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. *Please note that targeted review decisions are final and not eligible for further review.* 

*Targeted Review Resources:* 


* *2023 Targeted Review User Guide (PDF, 15MB)* [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2961/2023-Targeted-Review-Guide.pdf ] – Reviews the process for requesting a targeted review and examples for when you would or wouldn’t request a targeted review. 

* *2025 MIPS Payment Year Payment Adjustment User Guide (PDF, 710KB)* [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2962/2025-MIPS-Payment-Adjustment-User-Guide.pdf ] – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions. 
QPP Footer 2023 [ https://qpp.cms.gov/resources/help-and-support ]


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