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.

Discrepancy Report Form

Initial Report?

Indicate whether this report is an Initial Discrepancy Report or an Updated Discrepancy Report*

I. GENERAL INFORMATION


1. Survey Vendor Organization Information

2. Survey Vendor Contact Person

3. Date Discrepancy Was Discovered

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

Add Another ACO Name/ID

Add Next ACO

Add Another ACO Name/ID

Add Next ACO

Add Another ACO Name/ID

Add Next ACO

Add another ACO Name/ID

Add Next ACO

Add Another ACO Name/ID

Add Next ACO

Add Another ACO Name/ID

Add Next ACO

Add Another ACO Name/ID

Add Next ACO

Add Another ACO Name/ID

Add Next ACO

Add Another ACO Name/ID

Add Next ACO

III. DISCREPANCY INFORMATION

1. * Description of discrepancy and how it was discovered 

2. *Affected timeframe for each ACO listed (e.g., mm/dd/yyyy - mm/dd/yyyy) 

3. * For each ACO listed, provide:

  1. ACO ID
  2. Total sampled members
  3. Number of sampled beneficiaries affected by the discrepancy

4. * Description of corrective action you've taken to address discrepancy, along with proposed timeline 

5. * Additional information not provided above which will help the CAHPS for ACOs project team understand the discrepancy