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CMS Releases Guidance on How 2019 Payment Adjustments Will Be Indicated on Claims

October 23, 2018

McDermott+Consulting

The Centers for Medicare and Medicaid Services has released guidance to help Merit-based Incentive Payment System (MIPS) eligible clinicians understand how to identify and interpret the application of positive, neutral and/or negative MIPS payment adjustments to be applied to payments for certain claims submitted for services furnished in calendar year 2019 based on clinicians’ 2017 MIPS final scores.

When clinicians submit a claim to a Medicare Administrative Contractor (MAC), they will receive a Remittance Advice (RA) that explains the payment and any adjustment(s) made to a payment during Medicare’s adjudication of the claim. Three code types will be used to communicate information about MIPS payment adjustments on RAs.

CodesPositive AdjustmentNegative Adjustment
Claim Adjustment Reason Codes (CARCs)144: Incentive adjustment, e.g. preferred product/service237: Legislated/Regulatory Penalty
Remittance Advice Remark Codes (RARCs) N807: MIPS-based payment adjustment
Group CodeCO: This group code is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459, smadhani@mcdermottplus.com.

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