MIPS Audit Vulnerabilities and Preparations


Instructor: Michael Stearns
Product ID: 706326
Training Level: Intermediate to Advanced

  • Duration: 60 Min
MIPS Data Validation Audits started in June of 2019. The MIPS has a number of vulnerabilities related to its reporting requirements and associated complexities. This presentation will address potential vulnerabilities and provide specific recommendations that will help protect your practice from a negative audit.
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Why Should You Attend:

The Merit-based Incentive Payment System (MIPS) is a mandatory program for eligible Medicare clinicians. It is a component of the CMS Quality Payment Program. Practically 800,000 clinicians will be enrolled in the MIPS in 2020. Reporting requirements for this program are complicated and in many cases subject to interpretation. The presenter has had extensive interactions with CMS to obtain clarifications on a wide range of requirements for the program. MIPS Data Validation Audits are underway, and expected to identify numerous shortcomings that will result in penalties.

This presentation will identify common vulnerabilities in the MIPS program at a granular level and provide guidance on how to minimize the risk of a negative audit.

The complicated nature of the MIPS has created a program vulnerable to interpretation of complex guidelines. Practices are at risk for being penalized up to 9% of their Medicare Part B revenue based on 2020 performance if Medicare invalidates the data reported due to lack of documentation or other issues.

Based on audits performed for similar programs, CMS will likely recoup large sums of money from practices of all sizes. In most cases, the reporting errors will be due to lack of understanding of the detailed requirements of the MIPS.

Areas Covered in the Webinar:

  • Overview of MIPS requirements
  • Quality performance category requirements
  • Quality performance category audit vulnerabilities
  • Promoting Interoperability category requirements
  • Promoting Interoperability category audit vulnerabilities
  • Improvement Activities category requirements
  • Improvement Activities audit vulnerabilities
  • Cost performance category requirements
  • Cost performance category audit vulnerabilities, including supporting documentation for risk adjustment

Who Will Benefit:

  • Medicare eligible physicians and other clinicians
  • Health Information Management (HIM) professionals
  • Practice Administrators
  • Healthcare CMIOs
  • Healthcare COOs
  • Clinical staff members
  • Healthcare compliance professionals
  • Healthcare analytics professionals
  • Quality performance professionals

Free Materials:

  • Reference documents
  • Rule documents or guidance
  • Checklist
  • SOP template
  • Easy fill in forms
  • Articles
Instructor Profile:
Michael Marron Stearns

Michael Stearns
CEO, Apollo HIT, LLC

Michael Marron-Stearns, MD, CPC, CFPC is a physician informaticist, certified professional coder (CPC), and CEO of Apollo HIT, LLC. Dr. Marron-Stearns has 15 years of direct patient care experience. He served as an assistant professor and neurology residency program coordinator. For the past 21 years he has worked as a informaticist, health information technology and compliance professional. He spent 12 of these years providing leadership and direction to electronic health record vendors.

Dr. Stearns is an accomplished speaker and author on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that includes the MIPS and Advanced Alternative Payment Models. His company, Apollo HIT, LLC provides a range of consulting services to healthcare providers and health information technology organizations. One of his main areas of focus is compliance in the MIPS component of the Quality Payment Program. He was invited to speak on MIPS audit vulnerabilities at the Health Care Compliance Association’s Enforcement Conference in November 2019. Dr. Stearns is also written a series of articles on MACRA for the Journal of the American Health Information Association.

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