CMS Quality Payment Program Notice
Merit-Based Incentive Payment System (MIPS) Data Validation and Audit (DVA) Announcement Notice
MIPS DVA for the 2019, 2020, and 2021 Performance Years Will Begin January 2023.
The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse to conduct data validation and audits of MIPS eligible clinicians in accordance with the legislative authority set forth in 42 CFR 414.1390(a)-(d). This regulation requires MIPS eligible clinicians or groups to comply with data sharing requests, providing all data as requested by CMS. Data validation and audits are designed and conducted to confirm the accuracy and completeness of reported results of the MIPS program.
If you are selected for MIPS data validation and audit, you will receive a request for information from Guidehouse. The request will be e-mailed to selected clinicians via the MIPS DVA contractor’s email address (MIPS_DVA@guidehouse.com). You will have 45 days from the date of the notice to provide the requested information of substantive, primary source documents. These documents may include: copies of claims, medical records for applicable patients, or other resources used in the data calculations for MIPS measures, objectives, and activities. Primary source documentation also may include verification of records for Medicare and non-Medicare patients where applicable.
Please note, failure to provide the requested information for the data validation and audit could process result in a payment adjustment in accordance with the legislative authority set forth in §§ 405.980 through 405.986. It may also increase the possibility that you will be selected for future data validation and audits.
For additional information contact the Quality Payment Program help desk at 1-866-288-8292 or e-mail QPP@cms.hhs.gov