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Published Date:02/07/2019
Printed Date: 9/22/2015
URL: http://palmgba.com/marlowe/redesign6/article.html
Mandatory Payment Reduction – Sequestration Medicare Fee-For-Service (FFS) claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a 2 percent reduction in Medicare payment until further notice. The claims payment adjustment will continue to be applied to all claims after determining coinsurance, any applicable deductible, adding any positive Merit-based Incentive Payment (MIPS) adjustments and any applicable Medicare Secondary Payment adjustments. Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction.
This reduction appears on your remittance advice (RA) with CO-243 and an associated dollar amount. *Note: When the total allowed amount for an individual service is applied to the patient’s deductible the Sequestration reduction is not applied to that detail line.
Merit-based Incentive Payment System (MIPS) Payment Adjustments
MIPS positive payment adjustments appear on your RA with CO-144 and Reason and Remarks Code N807 along with an associated dollar amount. Negative amounts listed on an RA are processed as a positive amount paid.
MIPS negative payment adjustments appear on your RA with CO-237 along with an associated dollar amount. The associated dollar amount represents a reduction in payment. MIPS technical assistance and support is available to help you navigate the MIPS program. Visit the QPP website https://qpp.cms.gov/ or call 866-288-8292 weekdays from 8 a.m. to 8 a.m. Eastern Time.
MIPS negative payment adjustments appear on your RA with CO-237 along with an associated dollar amount. The associated dollar amount represents a reduction in payment.
MIPS technical assistance and support is available to help you navigate the MIPS program. Visit the QPP website https://qpp.cms.gov/ or call 866-288-8292 weekdays from 8 a.m. to 8 a.m. Eastern Time.
Calculating a MIPS Positive Adjustment with Sequestration Reduction Example:
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Last Updated: 02/07/2019