Possible MIPS Errors in 2019 Payment Adjustment

Recently, the Centers for Medicare and Medicaid Services (CMS) discovered an error in the implementation of the 2019 Merit-Based Incentive Payment System (MIPS) payment adjustment. It incorrectly applies adjustments to payments for Medicare Part B drugs and other non-physician services billed by physicians. Adjustments to affected claims will occur in the near future. According to the CMS, you don’t need to do anything. A CMS statement says,

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

Please be aware that adjustments to reimbursement for Part B drugs could be between +4% and -4%, depending on your practice’s MIPS adjustment based on 2017 performance.

The ACR encourages practices to review a sampling of their payments from Medicare with focus on MIPS adjustments, since excess drug payment recoupments could come as a surprise for those who don’t realize they were overcompensated to begin with.