Policy Update: MIPS Audits Are Now in Full Swing

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This policy update summarizes recent CMS guidance on MIPS data validation and audit activity, including the expanded audit contractor role, expected timelines, and the kinds of clinicians, submission methods, and performance categories that may be reviewed. It is aimed at clinicians, practice managers, compliance staff, and coding/reporting professionals who need to understand documentation retention and audit preparation for prior performance years.

Why This Topic Matters

MIPS participants may need to preserve supporting records for several years and be prepared for audit requests tied to prior submissions. Understanding the scope of CMS review helps organizations maintain appropriate files, coordinate responses, and reduce risk when performance data are examined.

Article Sections

  1. Overview

    Introduces the new CMS audit activity affecting MIPS data and explains why prior performance-year records may need to be retained.

  2. Here’s What You Need to Know

    Summarizes the audit process, including selection, response expectations, categories under review, and documentation retention considerations.

  3. Chances

    Highlights the kinds of records and submission patterns that may draw audit attention and notes practical steps for retaining supporting documentation.

  4. Tip

    Describes follow-up communication and file-handling considerations for organizations responding to CMS or contractor requests.

  5. Resource

    Points readers to the CMS resource library for additional MIPS audit materials and related performance-year guidance.

What You Will Learn

  • How CMS is organizing MIPS audit activity for prior performance years
  • What types of submission methods and performance categories are being reviewed
  • Why retaining supporting documentation for multiple years matters
  • How organizations can prepare for possible follow-up requests from CMS or its contractor
  • Where to find related CMS resource materials

Who Should Read This

  • MIPS-eligible clinicians
  • Practice managers
  • Compliance staff
  • Medical coders and auditors
  • Quality reporting staff

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