If you were eligible for the Merit-based Incentive Payment System (MIPS) in 2017, your score that year will affect how much you receive from Medicare claims submitted for services next year. It could be a penalty or an increase, depending on how well you did.
The Centers for Medicare & Medicaid Services (CMS) has released guidance to reduce any confusion. When a MIPS-eligible physician submits a claim to a Medicare Administrative Contractor (MAC), the physician receives a Remittance Advice (RA) that explains the payment and any adjustments made to the payment. MACs will use three code types to relay information about MIPS payment adjustments on RAs in 2019:
• Claim Adjustment Reason Codes (CARC): Either 144 (incentive adjustment) or 237 (legislated/regulatory penalty)
• Remittance Advice Remark Codes (RARCs): N807 (MIPS-based payment adjustment)
• Group Code: CO (used when either a contractual agreement between the payer and payee or a regulatory requirement resulted in an adjustment)
CMS will also notify Medicare beneficiaries if a claims payment made to one of their clinicians was adjusted because of the clinician’s participation in MIPS. Every three months, beneficiaries in original Medicare will receive a Medicare Summary Notice (MSN) in the mail for their Medicare Part A and Part B-covered services. MSNs show a beneficiary all his or her services or supplies that providers and suppliers billed to Medicare during the three-month period, what Medicare paid, and the maximum amount the beneficiary may owe the provider or supplier. For all of the beneficiary’s claims for which the clinician who furnished the service received a positive or negative MIPS payment adjustment, the following MSN message will be displayed: “This claim shows a quality reporting program adjustment” (or "Esta reclamación le muestra un ajuste del programa de informes sobre la calidad” in Spanish). A sample Part B MSN is available online.
– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians
Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights," featuring practical, peer-reviewed advice for improving practice, enhancing the patient experience, and developing a rewarding career.