Excerpts republished from the CMS Quality Payment Program Listserv from 6/20/2019.
The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse to conduct data validation and audits of a select number of Merit-based Incentive Payment System (MIPS) eligible clinicians. Data validation and audits are processes that will help ensure MIPS is operating with accurate and useful data. MIPS eligible clinicians, groups and virtual groups are required by regulation to comply with data sharing requests, providing all data as requested by CMS.
If you are selected for data validation and/or audit, you will receive a request for information from Guidehouse. It will be sent via email or by certified mail. Please be on the lookout for this notification. You will have 45 calendar days from the date of the notice to provide the requested information.
It is important to note that if you do not provide the requested information, CMS may take further action, to include the possibility that you will be selected for future audits. To help avoid this, CMS is in the process of developing resources to support clinicians chosen for validation or audit.
The following data validation and audit resources are available on the Quality Payment Program Resource Library:
- 2017 MIPS Data Validation Criteria - Lists the 2017 criteria used to audit and validate data submitted in each performance category
- 2018 MIPS Data Validation Criteria - Lists the 2018 criteria used to audit and validate data submitted in each performance category
- You don't have to have an EHR to avoid a penalty or earn a positive adjustment or bonus.
- It does not cost you any money to submit data.
If you are an eligible clinician, a LAMMICO insured and have not already implemented a process for capturing or reporting MIPS data in your practice, contact LAMMICO and let us help you! If you already have a MIPS process, we can be an additional resource and discuss options regarding MIPS. There is no charge for our consultation. These services are provided to you because you are a LAMMICO insured.
Participation in the Quality Payment Program may also help you mitigate your malpractice risk through tracking and improving quality care (Quality measures), increasing patient engagement and satisfaction (Improvement Activities) and improving communications using secure electronic transmissions between providers and with patients (Promoting Interoperability).
Contact LAMMICO Practice Management Specialist, Natalie Cohen, MBA, MHA, at 504.841.2727 or firstname.lastname@example.org.