MACRA Quality Payment Audit Preparations

Date: Tuesday April 21, 2020

10:00 AM PDT | 01:00 PM EDT

Duration: 60 Minutes
Instructor: Michael Stearns
Webinar Id: 801974
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One Attendee
Live + Recorded
$599 $678  
Unlimited Attendees ?

This presentation will address audit vulnerabilities in the Quality Payment Program that could have major consequences for healthcare organizations.  It will review best practices for reducing the risk of a negative audit. 


This presentation will review the audit vulnerabilities of the two tracks of the Quality Payment Program (QPP), the Merit-based Incentive Payment System MIPS) and Advanced Alternative Payment Models.(APMs).

Audits started in 2019 and are continuing. Given the structure of the MIPS, negative audits could lead to penalties as high as negative 9 percent during the corresponding payment year. Similar penalties may be levied against Advanced APM participants.

A significant number of QPP audit vulnerabilities have been identified and will be reviewed in this program.

The importance of clinical documentation integrity, data aggregation,and having a detailed and complete understanding of the performance and reporting requirements for each facet of the QPP will be emphasized.

Why should you Attend: A detailed understanding of MACRA is required in order for healthcare practices to be compliant and to avoid large penalties.

Starting with the 2020 performance year penalties for low score in the MIPS can reach as high as negative 9 percent, applied to all Part B payments in 2022.

Negative audits may reduce MIPS scores and/or be associated with large fines for falsely reporting data to CMS. CMS has emphasized the need for practices to submit data that is accurate and that has not been subjected to "cherry picking." CMS will also continue audits related to Advanced Alternative Payment Models such as ACOs.

The OIG is targeting the accuracy of quality measure data reported to CMS and looking at a number of additional factors.

Areas Covered in the Session:

  • MIPS Quality performance category audit vulnerabilities
  • MIPS Promoting Interoperability performance category audit vulnerabilities
  • MIPS Improvement Activities performance category audit vulnerabilities
  • MIPS Cost performance category audit vulnerabilities
  • Advanced Alternative Payment Model audit vulnerabilities
  • Establishing a QPP compliance program
  • Strategies to reduced the risk of a negative audit

Who Will Benefit:
  • Physicians
  • Clinicians
  • EHR Professionals
  • Analytics Professionals
  • Compliance Officers
  • Health Information Technology Professionals
  • Auditors
  • Consultants

Speaker Profile
Michael Stearns, MD, CPC, CFPC, is a physician informaticist, certified professional coder (CPC), certified family practice coder (CFPC). He is the CEO and Founder of Apollo HIT, LLC, an Austin-based company that provides consulting services in the areas of healthcare information technology and compliance. His company assists organizations with meeting their documentation, coding, EHR optimization and program goals, including their performance in the Merit-based Incentive Payment System and Alternative Payment Models.

During his career Dr. Stearns has received several awards for teaching and contributions to patient safety and patient privacy initiatives. He played a central role in the design and development of vocabularies at the National Institutes of Health (NIH) and provided a leadership to the development of the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). He has served in a leadership capacity for two leading EHR vendors and as an advisor to several emerging HIT organizations.

He is a cofounder and lecturer at the University of Texas at Austin Health Information Technology Certificate Program, a nationally recognized model for HIT workforce development. He has been invited to testify in Washington, D.C. before federally sponsored HIT policy and standards organizations on five separate occasions. He served as the founding board president of the Texas eHealth Alliance, an organization that provides stakeholder input related to health information technology policy matters to state legislators. He is also an accomplished author and lecturer on a range of health care quality, health information technology, coding/compliance and quality-based performance initiatives.

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