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CMS Announces the Beginning of MIPS Data Validation and Audits

CMS Announces the Beginning of MIPS Data Validation and Audits

It was not a matter of if but when.... when would the Centers for Medicare & Medicaid Services (CMS) review and audit Merit-based Incentive Payment System (MIPS) data submitted by eligible clinicians? We also wondered if they would use the same contractor who previously audited Meaningful use? Or would CMS hire another contractor?

We now know MIPS data validation and audits on a select number of eligible clinicians are about to begin. And according to CMS, Guidehouse is the contractor who is tasked with conducting data validation and audits which are said to be 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.

CMS said 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.
  • You will have 45 calendar days from the date of the notice to provide the requested information.
  • Per CMS, 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.

Finally, CMS provided the following links to data validation and audit resources:

Have additional questions? Contact us by email: support@hcp.md or by phone: 855-427-0427.

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