CMS Announces instructions to MACs to fix incorrect 2019 MIPS adjustments to Part B drugs

Date: February 9, 2019

As we reported on 1/31/2019 in a prior CCG Webnews (link here), some Medicare Administrative Contractors (MAC) are making adjustments on payments for Part B drugs, which is currently forbidden under Federal law.

Yesterday, CMS announced on a MLN Connects page that there was an error in the implementation of the 2019 MIPS payment adjustments.  The CMS announcement is a bit thin on specifics, but the announcement by one of the Medicare Administrative Contractors (MACs), Palmetto GBA, had more information.  Palmetto GBA states:

CMS discovered an error in the implementation of the 2019 Merit-based Incentive Payment System (MIPS) payment adjustment. It incorrectly applies payment adjustments for Medicare Part B drugs and other non-physician services billed by eligible clinicians (e.g., physicians and non-physician practitioners). Affected claims have a date of service of January 1, 2019, or after and CARC (claim adjustment reason code) 144 (positive adjustment) or 237 (negative adjustment) on the remittance.

 CMS has instructed Medicare Administrative Contractors to apply a partial fix that will bypass the current MIPS payment adjustment logic for some affected codes. This interim action will not capture all of the affected codes. However, it will significantly reduce the number of impacted claims. Additional coding changes will be required by the Multi-Carrier System (MCS) shared system maintainer to implement a permanent fix.

 Provider Action: No provider action is required. CMS will provide further instructions regarding necessary adjustments to address over and underpaid claims related to this issue and this claims payment issue will be updated at that time

As you can see, the temporary fix will catch most but not all adjustments, so in some cases corrections may take a while to be implemented.  We will post another CCG Webnews at that time.

We are happy to assist providers and groups in any way with other topics including MIPS in general, 2018 MIPS attestations, as well as proper code selection, chart reviews, payer action questions – please contact us.  We can also provide training on these or other subjects.  You can reach us via the link to our main webpage or at the phone number below.  You can also download our “App”, Corcoran 24/7, which can be separately accessed via one of the links below.

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