CMS finds errors in MIPS payment adjustments

Two months into 2019 and the Centers for Medicare & Medicaid Services (CMS) has discovered an error in how some physicians and practices are getting paid under the Merit-based Incentive Payment System (MIPS).

Last year, Congress made several changes to MIPS. Among those changes were new limits on how MIPS payment adjustments could be applied to certain professional services, including an exclusion on adjusting payments for such items as Part B drugs.

Recently, CMS said it discovered that some Medicare Administrative Contractors (MACs) have erroneously applied the payment adjustment to Part B drugs and other non-physician services billed by physicians. The agency says it is working to resolve the issue with the MACs.

In the meantime, you don’t need to take any action. CMS will adjust affected claims as follows:

• If Medicare overpaid a claim based on this error, you will get a notification for recoupment from your MAC.
• If Medicare underpaid a claim, it will be adjusted.

CMS has not said when affected physicians will see the update and correction. However, at least one MAC says mass adjustments would begin this month. More information is available on the Quality Payment Program website.

– Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians