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: