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Outpatient Therapy

Grow Your Rehab Therapy Practice Using Paid Ads and Search Engine Marketing

When done right, paid advertising and search engine marketing are amazing tools to reach new patients and grow your business. By applying several basic tactics, you can start using powerful digital advertising platforms like Google and Facebook to target specific audiences and help ensure a steady flow of business for your practice. Click to View […]

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Five Key Stressors Hospice Professionals Face, with Guidance for Support

Hospice professionals help others face death and loss, while juggling interdisciplinary communications, quality compliance regulations and ever-evolving technologies. You are continually there for families and their dear ones who are passing away. But what about you? Get the eBook In caregiving professions, it is easy to get swept up in the needs of others and forget […]

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Net Health’s CIO discusses diversity and how it can build a stronger organization

Diversity in the workplace is an on-going issue but it’s an issue with solutions. To build diversity, it takes forward-thinking initiatives, a reexamination of the hiring philosophy, and the support of the company’s decision-makers.  One such supporter of diversity in the workplace is Net Health’s CIO, Jason “JJ” James.  Recent social movements like Black Lives […]

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Tough Questions | Real Answers: Net Health’s Fireside Chat about Race

Net Health did something different recently. Nearly two hundred employees and their families gathered around their computer screens to take part in a landmark event in our company’s history – we called it a “Fireside Chat about Race”.  The purpose of this event was to have a truly open conversation about the controversial but relevant […]

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Industry News 2017 Merit-based Incentive Payment System Data Validation and Auditing

2017 Merit-based Incentive Payment System Data Validation and Auditing

September 1, 2017 by Cathy Hess , BSN, RN, CWCN, VP, Chief Clinical Officer for Wound Care

In previous columns, we have discussed the roadmap to Merit-based Incentive Payment System (MIPS) strategy and documentation. Your documentation may be subject to an audit so, you will need to provide information to verify your MIPS participation. This column will begin to discuss the data validation and audit criteria. In the next column, we will review a sample MIPS Audit Checklist. The following information is excerpted from https://qpp.cms.gov/about/resource-library (select hyperlink to MIPS Validation Criteria, April 26 zip file).

The Medicare Access and CHIP Reauthorization Act of 2015 streamlines a collection of programs with a single system where you can be rewarded for better care. You will be able to practice as usual, but you may receive higher Medicare payments based on performance. The 2 paths in this program are MIPS and Advanced Alternative Payment Models:

Under MIPS, 4 connected performance categories will affect your Medicare payments: Quality, Improvement Activities, Advancing Care Information, and Cost. This fact sheet provides a high-level overview of 3 of the MIPS performance categories for the transition year. Detailed criteria are included in an accompanying spreadsheet (https://qpp.cms.gov/about/resource-library/, MIPS Data Validation Criteria [zip file]). Note that criteria will be released incrementally according to the following schedule:

  • Improvement Activities—Spring 2017
  • Quality—Summer 2017
  • Advancing Care Information—Summer 2017

The Quality Payment Program Final Rule with comment requires the Centers for Medicare & Medicaid Services (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.

Data validation is the process of ensuring that a program operates on accurate and useful data. The 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.

Under MIPS, the CMS will conduct an annual data validation process. You could receive a request from CMS for an audit, which requires an initial response within 10 business days.

To read the full article in “Advances in Skin & Wound Care” by Cathy Thomas Hess, click here.

Read previous articles in “Advances in Skin & Wound Care” by Cathy Thomas Hess in the link.

Download a brochure and learn how Net Health 360 professional services programs conquer the most complex problems in specialized lines of work.


Cathy is Chief Clinical Officer for WoundExpert® and Vice President at Net Health, and in addition to being the MIPS Clinical Consultant for WoundExpert. She gained over 30 years of expertise in various acute care, long-term care, sub-acute care facilities, home-health agencies, and outpatient wound care department settings. Cathy is the author of Clinical Guide to Skin and Wound Care (also translated into Italian and Portuguese) – Eighth Edition published in September of 2018.

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Filed Under: Industry News, Wound Care

About the Author

Cathy Hess , BSN, RN, CWCN

VP, Chief Clinical Officer for Wound Care

Cathy oversees clinical and professional services for Net Health. Cathy gained over 25 years of expertise in various acute care, long-term care, sub-acute care facilities, home-health agencies, and outpatient wound care department settings. She is the author of The Clinical Wound Manager™ Manual Series, Clinical Guide to Skin and Wound Care – Seventh Edition (also translated into Italian and Portuguese).


See all posts by Cathy Hess , BSN, RN, CWCN

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