Your Practice
Under the Merit-based Incentive Payment System (MIPS), the Centers for
Medicare & Medicaid Services (CMS) conducts an annual data validation
process. Clinicians randomly are selected for the audit, and programs
historically have audited about one in 10 clinicians. Here’s what to do if
you’re one of the chosen.
CMS makes available the criteria used to audit and
validate measures and activities for the Quality, Promoting
Interoperability and Improvement Activities categories of
MIPS. This article will guide you through the information you
should keep so you’ll be prepared if you’re audited.
What does data validation mean?
Data validation is the process of ensuring that a program
operates on accurate and useful data. MIPS requires that
you use all-payer data for all data submission mechanisms,
except for claims and the CMS Web Interface. The process
through which CMS validates your data is commonly referred
18 Dallas Medical Journal December 2018
Audit Readiness
What you need to know
to as an audit. Data from payers other than Medicare will be
used to improve future validation efforts and will not be the
only source of data used to make final determinations on
whether you pass an audit.
What type of data is considered
accurate and useful?
Below are the items you need to retain in case of an audit.
Eligibility
For MIPS eligibility, it is recommended to retain the
following: