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CMS Announces MIPS Data Validation and Audits for Eligible Clinicians

MIPS Data Validation and Audits
17 Jan

CMS Announces MIPS Data Validation and Audits for Eligible Clinicians

 CMS announced MIPS data validation and audits for performance years 2019, 2020, and 2021.

This process is set to begin in January 2023. Clinicians and groups must comply with CMS requests for data to ensure analysis accuracy and completeness.

MIPS Data Validation and Audits

It is important that records and data be kept for at least 6 years whether you submitted data for attestation or submitted a hardship.

If selected for MIPS audit, you’ll receive an information request from Guidehouse (MIPS_DVA@guidehouse.com), the validation contractor. Once you receive this request, you will have 45 days to provide the required or requested information. Appropriate information sources should be primary source documents for the MIPS reporting years, including but not limited to:

  • Copies of billed claims
  • Medical records for applicable patients
  • Resources used in data calculations for the MIPS measures and objectives
  • Verification of records for Medicare and non-Medicare patients where applicable

Regularly check notices. Non-compliance may lead to payment adjustments and increase the chance of future audit selection.

Ensure your PECOS and NPPES accounts are updated for CMS to have accurate information. For a timely response, the designated recipient of the correspondence must be verified.

If you receive audit information requests or want to review past reports, hardship applications, or certifications, please contact us. Schedule a time with one of our MIPS consultants at 817-857-1075.