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News & Press: Government Affairs News

2019 MIPS Payment Adjustments Incorrectly Applied

Friday, February 8, 2019   (0 Comments)
Posted by: Bradley Coffey, MA, AAOE Government Affairs
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Baltimore, MD - As the first year of payment adjustments under the Merit-based Incentive Payment System (MIPS) begins, physicians and specialty societies are making CMS aware that the agency has been incorrectly applying payment adjustments to include excluded items and services, including Medicare Part B drugs. CMS is working with the Medicare Administrative Contractors (MACs) to correct these errors and has asked stakeholders to share the following FAQ with their members:

Q. Should payments for Medicare Part B drugs be included in the 2019 MIPS Payment Adjustment?

A: On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018, which contained provisions that made several changes to the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program, including no longer calculating the cost of Part B drugs in the low volume threshold.

 Recently, CMS discovered an error in the 2019 MIPS payment adjustment applied by the Medicare Administrative Contractors (MACs), which included the payments for Medicare Part B drugs.

 At this time, the Center for Medicare and Medicaid Services (CMS) is unable to provide an exact date of when impacted clinicians will see the update and correction, but we anticipate an adjustment in the near future. In the event that CMS overpaid a claim based on inclusion of the Medicare Part B drugs, a notification for recoupment will be issued from their MAC on behalf of CMS. 

 CMS is working as quickly as possible to resolve this issue. No further action is requested of clinicians. CMS sincerely apologizes for any inconvenience this error may have caused.


What do You Need to do?

At this time, physicians and practices experiencing incorrect payment adjustments do not need to do anything. If CMS overpaid a claim due to this error, the provider will receive a recoupment notice from their MAC. If the claim was underpaid, CMS will adjust it to the correct amount.


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