Quality Insights follows guidance in the CMS Measures Blueprint for measure development and maintenance, including testing measures for reliability and validity. In order to conduct the testing, a provider sample is generated from CMS claims data to ensure the measure is valid, reliable and feasible and appropriately based on the medical record.  Clinician response to a request for medical records is important to the process of continually validating the measure and ensuring the measure is functioning as designed.
If your facility recently received a letter from Quality Insights regarding its’ testing of a (CMS) Quality Payment Program (QPP) – Merit-based Incentive Payment System (MIPS) quality measure that you are reporting, please complete the instructions in the letter. The letter contains a request for medical record documentation, measure-related tool(s) as well as submission instructions.
Please note this is not an audit, and there is no financial penalty if it is determined that the submitted documentation does not support the code submitted. Rather we are simply testing the accuracy of the measure in order to validate its use or to improve the measure specification document to increase its precision.  By law, Quality Insights, Inc. may only provide aggregate information to CMS, and may not disclose your identity without your consent
Questions about this process may be directed to Shella Rauen at 800.642.8686, ext. 3219. You may also direct questions to the Quality Payment Program (QPP) Service Center at 866.288.8292.