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Update on Incorrect MIPS Payment Adjustments

Feb 08, 2019

The American Medical Association (AMA) and several specialty societies have made the Centers for Medicare and Medicaid Services (CMS) aware that physicians are incorrectly receiving 2019 MIPS payment adjustments on excluded items, including Medicare Part B drugs. CMS is working with their contractors to resolve the issue and asked the AMA to share the following FAQ as an update.:

Q. Should payments for Medicare Part B drugs be included in the 2019 MIPS Payment Adjustment?

A: On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018, which contained provisions that made several changes to the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program, including no longer calculating the cost of Part B drugs in the low volume threshold.

Recently, CMS discovered an error in the 2019 MIPS payment adjustment applied by the Medicare Administrative Contractors (MACs), which included the payments for Medicare Part B drugs.

At this time, the Center for Medicare and Medicaid Services (CMS) is unable to provide an exact date of when impacted clinicians will see the update and correction, but we anticipate an adjustment in the near future. In the event that CMS overpaid a claim based on inclusion of the Medicare Part B drugs, a notification for recoupment will be issued from their MAC on behalf of CMS. 

CMS is working as quickly as possible to resolve this issue. No further action is requested of clinicians. CMS sincerely apologizes for any inconvenience this error may have caused.”