Preparing For A MIPS Data Validation Audit: Key Steps For Success
Performance Year (PY) 2023 closed in March 2024, and final scores and incentive rates have recently been released, healthcare providers should now focus on preparing for the upcoming Merit-based Incentive Payment System (MIPS) Data Validation Audit (DVA). This audit ensures that the data submitted by MIPS-eligible clinicians is accurate and complete. If you are selected for an audit, understanding the necessary steps can help you save time, reduce stress, and avoid potential financial repercussions.
At KRK Value Based Consulting, we specialize in helping medical providers, healthcare administrators, and multispecialty organizations navigate these complex audits successfully.
What Is The MIPS Data Validation Audit?
The Centers for Medicare & Medicaid Services (CMS) contracts with Guidehouse to conduct MIPS data validation and audits. These audits verify the accuracy of the quality performance measures, cost categories, and other data reported by MIPS-eligible clinicians and groups. The goal of this audit is to ensure the integrity of the MIPS program and confirm that the data submitted reflects actual clinical performance.
For those selected for a PY2 2023 audit, notifications will be sent between October 2024 and April 2025. If you’re chosen, your Security Official will receive an email from Guidehouse with detailed instructions. You’ll have 45 days to submit the requested documentation, which could include patient records, claims data, and other source documents.
Key Steps For A Successful Data Validation Audit
Stay Proactive with Documentation
Documentation is crucial for a successful MIPS audit. Ensure that all data submitted during the MIPS reporting period is well-organized and accessible.
CMS publishes a Data Validation Audit Criteria file on the QPP website that lists the types of information needed to pass an audit for each measure or objective type. Practices should also retain copies of their MIPS dashboards from EMR and/or Registries.
Ensuring that your security measures are up to standard will help you avoid complications during the audit and demonstrate your commitment to regulatory compliance.
Failure to provide complete and accurate documentation may result in negative payment adjustments and increase your chances of future audits.
Review Your HARP Account
CMS uses the Health Care Quality Information Systems Access, Roles, and Profile (HARP) system to communicate with healthcare organizations. Make sure your contact information, especially that of your security official, is up to date in the HARP system. All audit notifications and requests will be sent to the email address on file. Failing to maintain accurate contact information can delay your response time and complicate the audit process.
Work with MIPS-Experienced Partners
Preparing for an MIPS audit can be overwhelming, especially for busy healthcare organizations. Collaborating with a value based care consultant like KRK Value Based Consulting can make the process smoother. We provide expert guidance, ensuring all required data is collected and submitted correctly. By leveraging our deep understanding of MIPS requirements and value based care, we can help minimize the burden on your internal teams.
Utilize MIPS Consulting and Training Resources
Healthcare organizations can greatly benefit from external MIPS consulting and training. KRK Value Based Consulting offers comprehensive support, from helping you gather the necessary documentation to providing training on MIPS measures, workflow implementation, and tracking your progress. Our consultants are well-versed in the MIPS program and can provide valuable insights on improving your MIPS score and maintaining compliance with the various requirements.
Ensure Compliance with MIPS Reporting Requirements
Regulatory compliance in healthcare is a top priority for all MIPS-eligible clinicians. When preparing for an audit, review all CMS quality measures and ensure that the data you’ve reported aligns with their guidelines. Compliance is key to maintaining your MIPS score and safeguarding your organization’s reputation.
The Role of KRK Value Based Consulting
At KRK Value Based Consulting, we understand the complexities of the MIPS program and offer tailored support to ensure your organization is fully prepared for an MIPS audit. From data collection to audit response, our team of experienced MIPS consultants will guide you every step of the way. With our Value Based healthcare consulting expertise, we help you navigate the challenges of MIPS compliance so you can focus on providing exceptional care to your patients.
Stay Ahead Of The Audit Curve
Whether you're proactively preparing for a potential MIPS data validation audit or have already been selected for one, taking the right steps can make all the difference. For practices that want to stay ahead, organizing documentation and ensuring compliance now can save time and stress in the future. By reviewing your MIPS submissions, updating contact information in your HARP account, and keeping all relevant records easily accessible, you can be well-prepared in case you’re selected for an audit.
On the other hand, if you've already received an audit notification, swift action is critical. Ensuring that all requested documentation is accurate and submitted within the 45-day window can help prevent negative payment adjustments. Collaborating with MIPS-experienced consultants like KRK Value Based Consulting can alleviate the burden by guiding you through the audit process and ensuring compliance every step of the way.
Regardless of your situation, partnering with expert consultants ensures you have the support you need to protect your MIPS scores and avoid potential financial penalties.
