AuditCare
Apiary Labs · Attestation Readiness
Apiary Labs · AuditCare
See where payment risk lives
before attestation closes
Estimate your hospital's exposure across CMS IQR structural measures, Hospital Value-Based Purchasing, and price transparency requirements, using your bed band and published CMS proxy rates.
Your hospital
IQR · Structural measures
4Ms · PSSM · Maternal
CMS Inpatient Quality Reporting, attestation payment adjustment
Select a bed band to see exposure range.
HVBP · Value-Based Purchasing
~2% base DRG at risk
Hospital Value-Based Purchasing, performance-adjusted payment
Select a bed band to see exposure range.
Price Transparency · CMS Rule
Civil monetary penalty
Hospital Price Transparency Rule, CMP exposure for non-compliance
Select a bed band to see exposure range.
Illustrative ranges only. IQR modeled as ~0.75% of estimated Medicare revenue by bed band; HVBP as ~2% of base DRG payments; price transparency as CMS civil monetary penalty schedule. Not legal or financial advice. Verify with your finance team and official CMS sources.
Risk profile fit
Higher risk
- IQR / NHSN attestations where evidence must survive audit
- Submitted last cycle but documentation is still ad hoc
- Multiple departments, one deadline, no shared evidence trail
- HVBP domain scores below benchmark
Lower risk
- No CMS hospital attestation scope
- GRC already owns structural documentation end-to-end
- Not subject to IPPS / Medicare base payment
Context
Why documentation gaps spiked (2024–26)
- Current IQR structural set — Age-Friendly, PSSM, and Maternal Morbidity, plus the annual DACA acknowledgement in the same HQR window. FY 2026 IPPS removed HCHE and the SDOH measures. Teams still running an HCHE cycle are preparing the wrong attestation.
- Who submits vs who is designated — HQR Structural MSR DACA Update submits Age-Friendly, Maternal, and DACA. PSSM is per-facility NHSN. Age-Friendly Domain 5 is a point person or committee, not a CMO/CNO signature.
- Submission ≠ defensibility — CMS can request evidence for any "yes." Filing without a file trail leaves you exposed the same as a miss.
- HVBP domain weight shifts — person and community engagement domains carry more weight starting 2025; hospitals that didn't track equity measures are seeing score pressure.
What each program actually measures
- IQR structural measures, attestation-based; CMS asks hospitals to affirm governance, protocols, and screening practices. Evidence is the differentiator.
- HVBP, performance on clinical care, safety, person & community engagement, and efficiency domains. Scores determine what % of the 2% withhold you get back, or lose.
- Price transparency, hospitals must publish a machine-readable file and shoppable services display. CMS conducts reviews and issues CMPs for non-compliance.
Questions finance and legal ask
- "We submitted last year without issues." Submission and documentation on request are different tests. Structural measures now carry explicit documentation expectations.
- "Quality already runs this manually." Most teams do. The bottleneck is coordinator time during operations, not willingness.
- "How do we verify before we spend?" Run the free assessment. If it surfaces unmapped gaps, the workflow pays for itself.
What a workflow tool changes
- Evidence map per attestation (CMS / TJC-style asks) before the window closes
- Owners + deadlines in one timestamped record instead of a shared spreadsheet
- Gap-to-risk translation across IQR, NHSN, CoP, Joint Commission NPGs, and VBP in one pass
- Leadership summary generated from your actual gap profile
AuditCare Professional: $5,000 / facility / year · cancel any time · full assessment free; the survey readiness binder and export are paid.