MIPS Data Validation Criteria

$179 / year

This dataset includes the MIPS Data Validation Criteria. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) streamlines a patchwork collection of programs with a single system where provider can be rewarded for better care. Providers will be able to practice as they always have, but they may receive higher Medicare payments based on their performance.

Complexity

The Quality Payment Program Final Rule with comment requires CMS to provide the criteria we will use to audit and validate measures and activities for the transition year of MIPS for the Quality, Advancing Care Information and Improvement Activities performance categories.

By definition, data validation is the process of ensuring that a program operates on accurate and useful data. MIPS requires all-payer data for all data submission mechanisms with the exception of claims and the CMS Web Interface. The data from payers, other than Medicare, will be used for informational purposes to improve future validation efforts and will not be the only source of data used to make final determinations on whether you pass or fail an audit in the transition year.

Date Created

2017-08-10

Last Modified

2017-08-10

Version

2017-08-10

Update Frequency

Irregular

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs; Quality Payment Program Resource Library;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Data Validation and Auditing, Data Validation Criteria, Improvement Activities

Other Titles

Advancing Care Information and Cost, MIPS Data Validation and Auditing 2017

NameDescriptionTypeConstraints
Activity_IDUnique Activity Identification Numberstring-
Subcategory_NameCategory Complete Namestring-
Activity_NameProvided Activity Namestring-
Activity_DescriptionDetail Description of Activitystring-
Activity_WeightingShows Activity weighting (High and Normal)string-
ValidationDetailed validation reportstring-
Suggested_DocumentationSuggested/ Required documents for activitiesstring-
Activity_IDSubcategory_NameActivity_NameActivity_DescriptionActivity_WeightingValidationSuggested_Documentation
IA_CC_4Care CoordinationTCPI participationParticipation in the CMS Transforming Clinical Practice Initiative.MediumActive participation in TCP InitiativeConfirmation of participation in the TCP Initiative for that year (e.g. CMS confirmation email)https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/
IA_BE_18Beneficiary EngagementProvide peer-led support for self-management.Provide peer-led support for self-management.MediumUse of peer-led self-managementDocumentation in medical record or EHR of peer-led self-management program. Peer-led self-management requires peer groups that include beneficiaries with the same condition or disease.
IA_BE_19Beneficiary EngagementUse group visits for common chronic conditions (e.g., diabetes).Use group visits for common chronic conditions (e.g., diabetes).MediumUse of group visits for chronic conditions. Could be supported by claimsMedical claims or referrals showing group visit and chronic condition codes in conjunction with care provided
IA_PSPA_9Patient Safety & Practice AssessmentCompletion of the AMA STEPS Forward programCompletion of the American Medical Association’s STEPS Forward program.MediumCompletion of AMA STEPS Forward program1) Certificate of completion from at least one AMA STEPS Forward program module; and2) Documentation of implementation from the module into the processes of care of your practice
IA_BE_12Beneficiary EngagementUse evidence-based decision aids to support shared decision-making.Use evidence-based decision aids to support shared decision-making.MediumUse of evidence based decision aids to support shared decision-making with beneficiaryDocumentation (e.g. checklist, algorithms, tools, screenshots) showing the use of evidence-based decision aids to support shared decision-making with beneficiary
IA_BE_7Beneficiary EngagementParticipation in a QCDR, that promotes use of patient engagement tools.Participation in a QCDR, that promotes use of patient engagement tools.MediumParticipation in QCDR promoting use of engagement toolsParticipation in QCDR that promotes use of patient engagement tools, e.g., regular feedback reports provided by the QCDR detailing activities promoting the use of patient engagement tools
IA_PSPA_13Patient Safety & Practice AssessmentParticipation in Joint Commission Evaluation InitiativeParticipation in Joint Commission Ongoing Professional Practice Evaluation initiativeMediumParticipation in Joint Commission Ongoing Professional Practice Evaluation initiativeDocumentation from Joint Commission's Ongoing Professional Practice Evaluation initiative confirming participation in its improvement program(s)
IA_PSPA_1Patient Safety & Practice AssessmentParticipation in an AHRQ-listed patient safety organization.Participation in an AHRQ-listed patient safety organization.MediumParticipation in an AHRQ-listed patient safety organizationDocumentation from an AHRQ-listed patient safety organization (PSO) confirming the eligible clinician or group's participation with the PSO. PSOs listed by AHRQ are here: http://www.pso.ahrq.gov/listed
IA_BE_10Beneficiary EngagementParticipation in a QCDR, that promotes implementation of patient self-action plans.Participation in a QCDR, that promotes implementation of patient self-action plans.MediumParticipation in a QCDR to promote implementation of patient self-action plansParticipation in QCDR that promotes implementation of patient self-action plans, e.g., regular feedback reports provided by the QCDR that show the promotion and use of patient self action plans
IA_CC_5Care CoordinationCMS partner in Patients Hospital Engagement NetworkMembership and participation in a CMS Partnership for Patients Hospital Engagement Network.MediumActive participation in Partnership for Patients Hospital Engagement Network (HEN) initiativeConfirmation of participation in the Partnership for Patients Hospital Engagement Network (HEN) initiative for that year (e.g. CMS confirmation email)https://innovation.cms.gov/initiatives/Partnership-for-Patients/