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MIPS Payment Adjustment Codes

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:

https://qpp-cm-prod-content.s3.amazonaws.com/uploads/260/2019-MIPS-Payment-Adjustment-Remittance-Advice-FAQs.pdf

https://qpp-cm-prod-content.s3.amazonaws.com/uploads/260/2019-MIPS-Payment-Adjustment-Remittance-Advice-FAQs.pdf

 

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

 


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