CAHPS® Survey for Accountable Care Organizations 
(ACOs) Participating in Medicare Initiatives
Discrepancy Report

Discrepancy Report Process

On occasion, a survey vendor may identify discrepancies from CAHPS for ACOs Survey protocols that require corrections to procedures and/or electronic processing to realign the activity to comply with CAHPS for ACOs Survey protocols. In its oversight role, the CAHPS for ACOs Survey project team may also identify discrepancies that require correction.

  • To formally notify CMS of discrepancies such as these, survey vendors are required to complete and submit a discrepancy report within one business day after the discrepancy has been discovered.
  • The discrepancy report notifies the CAHPS for ACOs Survey project team of the nature, timing, cause, and extent of the discrepancy, as well as the proposed correction and timeline to correct the discrepancy.
  • The survey vendor must include the ACO’s ID number on the form.

All required sections are indicated with an asterisk (*). The required information regarding the affected ACOs must be provided in Sections II and III in order to submit the CAHPS for ACOs Survey Discrepancy Report. If any information is unknown when you submit your report, enter “Pending” in any of the required fields in Section II and/or III. All pending information must be provided in an updated report within 7 days of submitting the Initial Discrepancy Report.

Indicate whether this report is an Initial Discrepancy Report or an Updated Discrepancy Report.
Initial Discrepancy Report * (Must be submitted within one business day of a discrepancy.)
Updated Discrepancy Report * (Must be submitted within one week of original Discrepancy Report.)

I. GENERAL INFORMATION

Survey Vendor Organization Information

The Name of the Organization is required.
08/19/2018
The Address is required.
The City is required.
The State is required.
The Zip Code is required.

Survey Vendor Contact Person

First Name is required.
Last Name is required.
Title is required.
Telephone is required.
Fax must at least 10 digits.
Email is required.

Date Discrepancy Was Discovered

Date Discovered is required.

II. *LIST ALL ACO NAMES AND NUMBERS IMPACTED BY THIS DISCREPANCY REPORT

At least one entry is required.
ACO Name is required.
ACO ID is required.
Add
(click on a row in the grid to edit it)

III. DISCREPANCY INFORMATION

Please complete items 3a through 3e below in detail. If any information is unknown at time of initial report, enter "Pending." All pending information must be provided in an updated report within 7 days of submitting the initial report.

Description of the discrepancy is required. {{2000 - model.DiscrepancyDescription.length}} characters remaining
Description of how the discrepancy was identified is required. {{2000 - model.DiscrepancyIdentified.length}} characters remaining
Affected timeframe is required. {{2000 - model.DiscrepancyTimeframe.length}} characters remaining
At least one entry is required.
ACO ID is required.
Total sampled members is required.
Number of sampled beneficiaries is required.
Add
(click on a row in the grid to edit it)
Description of the Corrective Action is required. {{2000 - model.CorrectiveAction.length}} characters remaining
Additional Info is required. {{2000 - model.AdditionalInfo.length}} characters remaining