Current Status

3/27/2019: Adjustments resulting in overpayments will have overpayment letters issued as follows:

Jurisdiction J and M Part B
Daily overpayment letters will be issued and include all overpayments identified that day (multiple claims = one demand letter)

Railroad

  1. Daily overpayment letters will be issued and include all overpayments identified that day (multiple claims = one demand letter), as long as the total of all ARs together is $10 or greater
  2. Claim overpayments of less than $10 will be aggregated with other claims with overpayments processed the same day, and will aggregate to a demand letter as long as the total of all ARs together is $10 or greater (multiple claims = 1 demand letter)
  3. For any overpayment amounts less than $10 that cannot be aggregated to over $10, the claims are closed and written off and no demand letter is issued
    • An aggregation process runs monthly. If a provider has multiple overpayments under $10 not already included on a demand letter, the overpayments will be reviewed the following month for the previous month. If the overpayments aggregate to $10 or more, a demand letter will be sent. If the overpayments do not aggregate to $10 or more, the overpayments are closed and no demand letter will be issued.

Issue Identified: February 5, 2019

Issue: 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.

Status:
3/27/2019: Adjustments resulting in overpayments will have overpayment letters issued as follows:

Jurisdiction J and M Part B
Daily overpayment letters will be issued and include all overpayments identified that day (multiple claims = one demand letter)

Railroad

  1. Daily overpayment letters will be issued and include all overpayments identified that day (multiple claims = one demand letter), as long as the total of all ARs together is $10 or greater
  2. Claim overpayments of less than $10 will be aggregated with other claims with overpayments processed the same day, and will aggregate to a demand letter as long as the total of all ARs together is $10 or greater (multiple claims = 1 demand letter)
  3. For any overpayment amounts less than $10 that cannot be aggregated to over $10, the claims are closed and written off and no demand letter is issued
    • An aggregation process runs monthly. If a provider has multiple overpayments under $10 not already included on a demand letter, the overpayments will be reviewed the following month for the previous month. If the overpayments aggregate to $10 or more, a demand letter will be sent. If the overpayments do not aggregate to $10 or more, the overpayments are closed and no demand letter will be issued.


3/19/2019: Affected claims have been adjusted. Please be aware that all adjusted claims will still need to continue through the claim processing system and it may take a period of weeks for all the adjustments to finalize. If a provider received a positive MIPS payment in error for certain services, overpayment request letters will be sent once the adjusted claims have finalized.

2/14/2019: The Multi-Carrier System (MCS) Shared System Maintainer installed a permanent fix on February 13, 2019, and mass adjustments will begin on March 1, 2019. This log will be updated when adjustments have been completed.

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