Watch for MIPS Data Validation and Audit Request
By Emma Freer

Physicians who participate in Medicare’s Merit-Based Incentive Payment System (MIPS) soon may receive a data-sharing request, or audit, as part of a legitimate federal oversight process, and compliance is required to avoid penalties. 

The Centers for Medicare & Medicaid Services (CMS) contracted with Guidehouse, a third party, to conduct a data validation and audit of MIPS for the 2019, 2020, and 2021 performance years. Selected clinicians will be notified via email (from MIPS_DVA@guidehouse) of any data-sharing requests starting in January and should be prepared to respond in full, Texas Medical Association experts caution.  

“Data validation and audits are designed to confirm the accuracy and completeness of reported results of the MIPS program,” CMS explained in the Dec. 5 announcement. 

If you’re chosen for a data validation and audit, you will have 45 days from the date of notice to provide the requested information, which may include copies of claims; medical records for applicable patients; and other resources used in the data calculations for MIPS measures, objectives, and activities. 

Ogechika Alozie, MD, an infectious disease specialist in El Paso and chair of TMA’s Committee on Health Information Technology, offers the following advice to physicians facing an audit:  

  • Document everything by saving screenshots in a safe space. By the time an audit occurs, you may have upgraded or changed your electronic health record, which could impede your ability to access past MIPS reports. 
  • Keep documentation for six years. 
  • Maintain up-to-date, accurate information related to the Medicare Provider Enrollment, Chain, and Ownership System, also known as PECOS, including your practice email address, where any notice will be sent.  

CMS warns failure to provide all requested information may result in a payment adjustment or an increased chance of being selected for data validation and audits in the future. 

Last Updated On

December 14, 2022

Originally Published On

December 14, 2022

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Emma Freer

Associate Editor

(512) 370-1383
 

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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