Is your practice “MIPS Audit-Proof?”
The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse, formerly part of PwC, to conduct data validation and audits of a select number of Merit-based Incentive Payment System (MIPS) eligible groups and clinicians. A MIPS audit can happen up to six years after the performance year!
Data validation and audits are the processes CMS uses to 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 and to provide all data as requested by CMS.
If you or your practice 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, so 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, so you will want to act swiftly and efficiently. If the requested information is not provided, CMS may take further action, including the possibility of marking you for additional audits in the future.
As part of their review, auditors will be looking at a MIPS eligible clinician’s:
MIPS participation status
Eligibility
Performance categories and weights
Data completeness for Quality
Report Documentation
Improvement Activity Data Validation
These are all standard items Chirpy Bird prepares for its clients in their Annual Book of Evidence. That’s right – we compile this information for every client, every performance year.
Remember, if you fail a MIPS audit, there can be significant financial and program implications.
If you get an audit notification consider reviewing the official CMS QPP resource:
Or, better yet, call Chirpy Bird. Our experts can work on your behalf to communicate with the auditor, help you gather the right information the first time, and reply to audit questions or inquiries to help take the anxiety out of the process.
