VBP QIP P4P Attestation

Submission Guidelines

  • Attestation is also available in Portable Document Format (PDF)

Each Facility participating in the Value Based Purchasing Quality Improvement Program (VBP QIP) is expected to provide pay for performance (P4P) measure results quarterly using a "rolling annual" calculation. The report on measure performance must be accompanied by an attestation signed by a senior leader within the facility confirming the accuracy of the data provided by the Facility.

VBP QIP Facilities must submit this attestation to their paired MCO together with the Facility to MCO VBP QIP Quarterly P4P report. Refer to the VBP QIP Facility Plan Guidance Document for any questions on how to complete the Facility to MCO VBP QIP Quarterly P4P Report.

Attestation

I, _____(Name)________________, employed by ______(Facility Name) ___________, as ________(Title)___________, hereby attest that the demonstration year __(Year)___ quarter __(Quarter)____ performance and baseline data provided in the attached Facility to MCO VBP QIP Quarterly P4P Report, has been reviewed and is deemed accurate.


Date                                    _______________________________

Authorizing Signature:     _______________________________