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Round two of the audits are happening NOW!
The first round of audits hit in January with deadlines in late March. These audits largely targeted individual clinicians and individual quality measures.
Here's what they're asking for:
Guidehouse auditors ask for a listing of patient data (including unique identifier, DOB, DOS) that qualified them for the numerator, denominator, exceptions and exclusions of a specific quality measure.
Submit this data via an upload to the Kiteworks portal, in the form of a spreadsheet.
The follow up by Guidehouse to that submission is a request for copies of a specific sub-set of patient records (typically around 15) to be uploaded to the Kitehouse portal.
The SECOND ROUND of audits just started. These are targeting individual clinicians AND groups. Again, these audits seem to focus on a specific quality measure (not necessarily the same between an individual clinician and their associated group). The deadline for these is mid to late April.
What You Can Expect If Selected
Guidehouse will be conducting these audits and eligible groups/eligible clinicians (ECs) will be notified via email. You have 45 days to respond and they will terminate the audit with a specific deadline date.
--------- HOT TIP --------- Add mips_dva@guidehouse.com to your contacts to ensure the email doesn't funnel to your junk box.
Per the official email from CMS: "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.
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."