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.


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.

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United States


John Snow Labs => Quality Payment Program Resource Library

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Data Validation and Auditing, Data Validation Criteria, Improvement Activities

Other Titles

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

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-
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
IA_CC_4Care CoordinationTCPI participationParticipation in the CMS Transforming Clinical Practice Initiative.HighActive participation in TCP InitiativeConfirmation of participation in the TCP Initiative for that year (e.g. CMS confirmation email)
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 programCertificate of completion from AMA's STEPS Forward program
IA_BE_22Beneficiary EngagementImproved practices that engage patients pre-visitProvide a pre-visit development of a shared visit agenda with the patient.MediumPre-visit agenda shared with patientDocumentation of a letter, email, portal screenshot, etc. that shows a pre-visit agenda was shared with patient
IA_PSPA_12Patient Safety & Practice AssessmentParticipation in private payer CPIAParticipation in designated private payer clinical practice improvement activities.MediumParticipation in private payer clinical practice improvement activitiesDocuments showing participation in private payer clinical practice improvement activities
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 claims.Medical claims or referrals showing group visit and chronic condition codes in conjunction with care provided
IA_PM_8Population ManagementParticipation in CMMI models such as Million Hearts CampaignParticipation in CMMI models such as the Million Hearts Cardiovascular Risk Reduction ModelMediumInvolvement in a CMMI model including acceptance and model participation. (Could be obtained from CMMI)CMMI documents confirming participation in model and submission of requested data
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 initiativePractice documents that show participation in Joint Commission's Ongoing Professional Practice Evaluation initiative
IA_CC_7Care CoordinationRegular training in care coordinationImplementation of regular care coordination training.MediumInclusion of regular care coordination training in practiceDocumentation of implemented regular care coordination training within practice, e.g., availability of care coordination training curriculum/training materials and attendance or training certification registers/documents
IA_PSPA_14Patient Safety and Practice AssessmentParticipation in Bridges to Excellence or other similar programParticipation in other quality improvement programs such as Bridges to ExcellenceMediumParticipation in other quality improvement programs such as Bridges to ExcellenceDocumentation from Bridges to Excellence or other similar program confirming participation in its improvement program(s)