Now that it’s 2019, MIPS clients may be seeing a positive or negative payment adjustment on their Remittance’s based on the clinicians 2017 MIPS final score. The adjustments will be showing up on all the EOB/ERA’s as positive or negative with every Medicare payment. To be prepared, please create the adjustment codes in the PM so that your billing department can post accordingly.
INSTRUCTIONS:
Go to Master Files | Transaction Codes | Payment Reason Codes.
- Enter the new code (see below for further code details)
- CO144 for a positive MIPS adjustment
- CO237 for a negative MIPS adjustment
- Enter a Description for the code
- Select any other option you prefer for the code
- Click Save
For positive MIPS payment adjustments, the following codes will be displayed:
- Group Code: CO. This group code is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment.
- Claims Adjustment Reason Code (CARC) 144: “Incentive adjustment, e.g. preferred product/service.”
- Remittance Advice Reason Code (RARC) N807: “Payment adjustment based on the Merit-based Incentive Payment System (MIPS).”
For negative MIPS payment adjustments, the following codes will be displayed:
- Group Code: CO. This group code is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment.
- Claims Adjustment Reason Code (CARC) 237: “Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)”
- Remittance Advice Reason Code (RARC) N807: “Payment adjustment based on the Merit-based Incentive Payment System (MIPS).”
For additional information, see the following two documents:
NOTE: To see your 2017 score and adjustment rate, login to your account on the QPP website.
Select Performance Feedback to see your final score and adjustment rate
