Hospitals : Public Reporting : Data Validation

In support of the Hospital Quality Alliance (HQA) and Reporting Hospital Quality Data for Annual Payment Update (APU) Initiative, the Centers for Medicare & Medicaid Services (CMS) will be conducting a quarterly retrospective validation for all hospitals submitting data to the Quality Improvement Organization (QIO) Clinical Warehouse. Once the data has been submitted to the QIO Clinical Warehouse, it will be subject to the following sampling and validation process.

The chart audit validation process is performed to ensure the data collected and reported is accurate. To do this, CMS will take the following approach:

• For each calendar quarter, a simple random sample of five charts will be identified from all hospitals with a minimum of six discharges in the QIO Clinical Warehouse. The sample is selected from all the cases submitted and is not topic-specific.
• The CMS Clinical Data Abstraction Center (CDAC) will request the paper medical records for each of the sampled charts from the hospital. Hospitals will have 30 calendar days to submit the five records. Any requested medical records not received by the CDAC before the deadline will fail validation. Follow these instructions to run the Validation Case Selection Report to view the cases requested for validation of your hospital's submitted records.
• The CDAC will re-abstract the chart using the CMS Abstraction & Reporting Tool (CART). The relevant differences will be identified and the CDAC will assign a reason code to each difference noted. See the Specifications for Calculating Hospital Validation Results.
• Based upon the CDAC re-abstraction, the percent agreement at the element level will be calculated. Hospitals that meet or exceed 80 percent agreement in the abstractions will be considered to be supplying valid data for that quarter and will pass validation.
• The results of the CDAC's re-abstraction will be available via QualityNet. Hospitals will receive an email when a report on their validation status is available. Follow these instructions to run a QualityNet report on your hospital's validation results.
• Hospitals that fail validation (less than 80 percent agreement across abstractors) will have the opportunity to appeal the decision. Hospitals have 10 business days after the day the report is posted to complete and submit an appeal form to the New Mexico Medical Review Association (NMMRA) via QualityNet.
• NMMRA will review the appeal to determine whether the CDAC's decision should stand. Appropriate appeals will be submitted by NMMRA to the CDAC with explanation. The CDAC will then re-review the record and the appeal and make a final decision.
• Hospitals that fail validation will not have data reported on the Web site for inclusion in the HQA/APU Initiative.
• See the Hospital Data Validation Flowchart more information.