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.
Please note, 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 selected to participate.
CMS currently has the following data validation and audit resources 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
Be sure to subscribe to the QPP listserv by entering your email at the bottom of the Quality Payment Program website so that you receive notifications about the most up to date MIPS Data Validation and Audit information available.
How do I get Help or More Information?
The Quality Payment Program can be reached at QPP@cms.hhs.gov or 1-866-288-8292 (TTY 1-877-715- 6222), Monday through Friday, 8:00 AM-8:00 PM Eastern Time.