MIPS Payment Adjustments Skip to main content Quick Links Find Info For Find Info For Help with QPP Help with MIPS Quick Links Subscribe Careers Purdue Healthcare Advisors Regenstrief Center for Healthcare Engineering Home About Overview Staff Directory Employment History Contact and Directions COVID-19 Events News Programs Services Online Courses LDI Course Home Programs QPP Resource Center Indiana MIPS Payment Adjustments Back: QPP Resource Center Indiana MIPS Payment Adjustments Deciphering 2019 MIPS payment adjustment remittance advice (RA) codes 2019 Merit-based Incentive Payment System (MIPS) adjustments based on your 2017 participation are now in effect. These adjustments are applied to payments made for covered professional services furnished by a MIPS-eligible clinician (EC) in calendar year 2019. They do not apply to payments for Medicare Part B drugs or other items/services that are not covered professional services. When a 2019 MIPS payment adjustment is applied to a payment made to a MIPS EC, the following codes are displayed on your RA: Positive ( + ) Adjustment CARC 144 "Incentive adjustment, e.g. preferred product/service" RARC N807 "Payment adjustment based on the Merit-Based Incentive Payment System (MIPS)." 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. Negative ( - ) Adjustment: CARC 237 "Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)" RARC N807 "Payment adjustment based on the Merit-Based Incentive Payment System (MIPS)." 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. Frequently-asked questions Q: I received a positive payment adjustment for my 2017 MIPS, why am I seeing a negative adjustment? A: One word: sequestration. We’ve gotten this question quite frequently recently, so wanted to provide a quick review of sequestration and how it affects the MIPS payment adjustments. Q: Seques-what? A: Sequestration is a mandatory payment reduction in the Medicare Fee-For-Service (FFS) program, set forth in the Budget Control Act of 2011. This Act, among other things, requires mandatory across-the-board reductions in Federal spending, called “sequestration.” Sequestration’s effective date was postponed in the American Taxpayer Relief Act of 2012. As required by law, President Obama issued a sequestration order on March 1, 2013. Q: How long does it last? A: The sequestration order covers all payments for services with dates of service, dates of discharge, or start date (for rental equipment or multi-day supplies) on or after April 1, 2013. Medicare FFS payments will incur a 2% reduction (-2%), until further notice. The claims payment adjustment are applied to all claims after determining coinsurance, any applicable deductibles, and any applicable Medicare Secondary Payment adjustments. Q: How does it affect my MIPS positive adjustment? A: When you see the CARC 144 and RANC N807 codes on your RA, you know you are receiving your positive payment adjustment for your 2017 MIPS participation. However, due to sequestration, that positive adjustment may be displayed as a negative number. Resources: 2019 MIPS Payment Adjustment Fact Sheet, QPP.CMS.gov. 10/14/2018. 2019 MIPS Payment Adjustment FAQs and Resources, QPP.CMS.gov. 02/22/2019. 2019 MIPS Payment Adjustment Remittance Advice (RA) FAQs, QPP.CMS.gov. 11/05/2018. Remittance Advice (RA) Information - An Overview, Medicare Learning Network. October 2018. CMS Medicare FFS Provider eNews, Medicare Learning Network. 03/08/2013. QPP Resource Center Indiana MIPScast Quality Payment Program (QPP) MIPS-eligible Clinicians MIPS Payment Adjustments Contact Natalie Stewart MBA Assistant Director, Quality Services 765-496-1265 765-517-1682 nmstewart@purdue.edu Sign up for PHA eNews to receive twice-monthly emails on news and training opportunities. Some conferences and webinars are listed here. Announcements Purdue's Regenstrief Center and IU Health to lead fight against opioids in two Indiana communities Aug 24 Led by Purdue and IU Health, CORE-ECI — a consortium of university, health care, faith-based and local government entities — will work to improve prevention, treatment and recovery services in Blackford and Jay Counties ... Purdue staff elected to lead executive boards of two healthcare associations Sep 1 Tara Hatfield and Leigh Ann Griffin to lead the board of directors of two Indiana healthcare-related associations. ... 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