Compliance: Know the Facts on MIPS Audits

Why This Topic Matters

MIPS reporting can affect future payment adjustments, and audit activity can lead to repayment or other consequences if documentation does not support submitted data. Understanding the broad audit process, recordkeeping expectations, and response timelines helps practices reduce compliance risk and stay prepared for CMS reviews.

Article Sections

1. 2019 participation and payment overview

   Summarizes the 2019 Quality Payment Program participation framework and discusses the general payment-adjustment context for MIPS-eligible clinicians. It also points readers to a CMS participation lookup resource.

2. Why CMS audits MIPS data

   Explains the compliance purpose behind CMS review activity and describes the general distinction between pre-incentive and post-incentive audits. It also notes the role of documentation in supporting submitted performance data.

3. Documentation, retention, and response timelines

   Covers broad recordkeeping expectations, audit-response timing, and the length of time certain performance documentation should be retained. This section also mentions how different performance categories may be treated from a documentation standpoint.

4. Audit contractors and consequences

   Identifies the type of outside contractor involved in Medicare MIPS audits and notes that related review outcomes can have financial or enforcement consequences. It closes with a resource link for additional MIPS guidance.