CMS Announces MIPS Data Validation and Audits for Eligible Clinicians

CMS Announces MIPS Data Validation and Audits for Eligible Clinicians

CMS has released a notice stating they will be conducting MIPS data validation and audits for the performance years 2019, 2020, and 2021.

This process is set to begin in January 2023. Regulations require both individual clinicians and groups to comply with any requests to provide data for CMS to conduct its analysis for accuracy and completeness.

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 you are selected for MIPS data validation and audit, you will receive a request for information from Guidehouse ( ), the MIPS data 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

It is important to regularly check for any notices as failure to comply could result in payment adjustments and the possibility of being selected again for future audits.

Please make sure your PECOS and NPPES accounts are up to date as well so that CMS has the most accurate information. It is imperative that you verify the individual who will be receiving the correspondence to be able to respond in a timely manner.

If you receive any requests for information for an audit or would like to further review past reports, hardship applications, or associated certifications for submission please contact one of our MIPS consultants to schedule a time to to discuss at 817-857-1075.