CMS Is Conducting MIPS Audits – Here’s What Physicians Need to Know

Last Updated: Jun 26, 2019

Audit-ManThe Centers for Medicare and Medicaid Services (CMS) has begun the process of audits and data validation for select clinicians eligible for the Merit-based Incentive Payment System (MIPS). The audits are being conducted for the 2017 and 2018 MIPS performance years.

Check out these quick facts about the audits and what to expect if you are selected:

  • CMS has contracted with the vendor Guidehouse to conduct the data validation and audits.
  • A select number of MIPS-eligible clinicians will be chosen to participate.
  • MIPS eligible clinicians, groups, and virtual groups are required by regulation to comply with data sharing requests.
  • You will receive a request for information from Guidehouse by email or by certified mail if you are selected for an audit and/or data validation. CMS advises clinicians and groups to be on the lookout for this notification.
  • If you are selected, you will have 45 days from the date of your notice to provide the requested information. CMS says that it may take further action on groups that do not respond to the audit requests, including the possibility of being selected for future audits.

CMS offers the following resources on audits and data validation through its Quality Payment Program Resource Library:

If you have questions about the audit process, you can contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292 (TTY 1-877-715- 6222), Monday through Friday, 8 a.m. - 8:00 p.m.

Pennsylvania Medical Society members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org

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