Outpatient Facility Coding Alert - 2019 Issue 9
Reimbursement: Find Out Your Chances of a MIPS Audit
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Article Overview
This article explains CMS’s MIPS data validation and audit activity under the Quality Payment Program and summarizes the kinds of participants, submissions, and documentation that may be reviewed. It is intended for clinicians, practice managers, and coding or reimbursement professionals who need to understand general audit readiness, record retention expectations, and the categories of MIPS activity discussed in current CMS guidance.
Why This Topic Matters
MIPS participants may need to maintain supporting records and be prepared to respond to CMS requests if selected for review. Understanding the scope of the audit process helps practices manage documentation, coordinate responses, and reduce risk around submission support files.
Article Sections
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Here’s What You Need to Know
An overview of the CMS audit process and the general response expectations for participants selected for review. It also notes the types of submissions and participant groups that may be included in the sampling.
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Chances
A summary of the documentation-retention perspective and the factors that may affect whether a participant is contacted for validation. It also covers general advice about keeping supporting records and monitoring submission activity.
What You Will Learn
- What the CMS MIPS audit and data validation process covers
- Which general categories of MIPS activity may be reviewed
- What kinds of documentation retention are discussed in the article
- What participant groups and submission methods are referenced
- How the article frames audit readiness and file management
Who Should Read This
- Clinicians participating in MIPS
- Practice managers
- Reimbursement and compliance staff
- Medical coding professionals
- Quality reporting staff
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