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 clinicians for performance years 2017 and 2018.
Data validation and audits are the process CMS will use 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, 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, 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. If the requested information is not provided, CMS may take further action, including the possibility of selection for future audits.
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.
As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.
Kirk Reinitz, CPA