MIPS Data Validation and Audit to begin June 2019 for Performance Years 2017 and 2018

June 21, 2019
Health Policy

The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse to conduct data validation and audits of a select number of Merit-based Incentive Payment System (MIPS) eligible clinicians.  Data validation and audits are processes that will help ensure MIPS is operating with accurate and useful data. MIPS-eligible clinicians, groups, and virtual groups are required by regulation to comply with data-sharing requests, providing all data as requested by CMS.

If you are selected for data validation and/or audit, you will receive a request for information from Guidehouse. It will be sent via email or by certified mail.  Please be on the lookout for this notification. You will have 45 calendar days from the date of the notice to provide the requested information.

Please note that if you do not provide the requested information CMS may take further action, including the possibility that you will be selected for future audits. To help avoid this, CMS is in the process of developing resources to support clinicians selected to participate.

CMS currently has the following data validation and audit resources available via the Quality Payment Program Resource Library:

Be sure to subscribe to the QPP listserv by entering your email at the bottom of the Quality Payment Program website so that you receive notifications about the most up-to-date MIPS Data Validation and Audit information available.

How Can You Get Help or More Information?

The Quality Payment Program can be reached at QPP@cms.hhs.gov or 1-866-288-8292 (TTY 1-877-715- 6222), Monday through Friday, 8:00 AM-8:00 PM ET.

Tax terms: CMS, MIPS, MACRA, QPP, Practice Management, Practitioners

QPP Submissions No Longer Support XML Format

As a reminder, Quality Payment Program (QPP) submissions will no longer support QPP XML format starting January 2, 2020. The QPP Submissions API will only accept requests and return responses in QPP JSON format.

This means that files must be uploaded to the QPP website in either QPP JSON or QRDA III XML. This change improves the Submissions API performance and eliminates security vulnerabilities related to XML.

Who Is Impacted?

The deprecation of QPP XML means that if you’ve ever configured your software to send requests to the QPP Submissions API or provided a file for your client to upload to the QPP website in QPP XML format, you will need to update your software to send those requests in QPP JSON format.

Please review the timeline below for key dates on QPP XML deprecation.

Organizations that already submit in QPP JSON are not impacted.

This does not apply to QRDA III XML; that converter tool will remain available to convert QRDA III XML to QPP JSON.

Key Dates for QPP XML Deprecation

  • Summer 2019: The QPP Submissions API Developer Preview environment for Year 3 launches and accepts QPP JSON only

o   Developer Preview environment: The QPP Submissions API in this environment will only accept requests in QPP JSON format

o   Production environment: The QPP Submissions API in this environment will still accept requests in QPP JSON and QPP XML format

o   Interactive documentation: This website will only document the API in QPP JSON

o   Static documentation: This website will only document the API in QPP JSON

  • January 2020: The production QPP Submissions API begins accepting Year 3 performance year data; all requests to the production QPP Submissions API on and after this date accepts QPP JSON format only

o   Static documentation: This website will only document the API in QPP JSON

o   Developer Preview environment: The QPP Submissions API in this environment will only accept requests in QPP JSON format

o   Production environment: The QPP Submissions API in this environment will only accept requests in QPP JSON format

o   Interactive documentation: This website will only document the API in QPP JSON

o   Static documentation: This website will only document the API in QPP JSON

CMS will be posting reminders about each of these key dates through the Google Group for QPP APIs. 

CMS recommends migrating as soon as possible to ensure you don’t experience any disruption.

Where to go for Support in Migrating to QPP JSON