AuditCare
Apiary Labs · Compliance Toolkit
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 — grounded in your bed band, not a generic number.
Your hospital
IQR · Structural measures
4Ms · PSSM · HCHE
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)
- New structural measures — 4Ms, PSSM, and HCHE added attestation requirements that most teams haven't fully operationalized: protocols, governance records, screening data.
- HCHE on Care Compare — CY2024 scores became public in Jan 2026; the market now sees whether you attested and with what.
- 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 is not the same as proof on request. Structural measures added explicit documentation expectations after the window closed.
- "Quality already runs this manually." — Most do. The constraint is coordinator time competing with operations, not intent. The tradeoff is labor vs. closing gaps before the window.
- "How do we verify before we spend?" — Run the free assessment. If it surfaces gaps you hadn't mapped, the workflow pays for itself. If not, stop.
What a workflow tool changes
- Evidence map per attestation (CMS / TJC-style asks) before the window closes
- Owners + deadlines in one timestamped record, not a shared spreadsheet
- Gap-to-risk translation across IQR, NHSN, CoP, NPSG, equity, and VBP in one pass
- Leadership summary generated from your actual gap profile
AuditCare Professional: $5,000 / facility / year · cancel any time · free assessment first.