October 23, 2018
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.
|Codes||Positive Adjustment||Negative Adjustment|
|Claim Adjustment Reason Codes (CARCs)||144: Incentive adjustment, e.g. preferred product/service||237: Legislated/Regulatory Penalty|
|Remittance Advice Remark Codes (RARCs)||N807: MIPS-based payment adjustment||
|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|