Medicare Payment Adjustments Home What's New at NWAHEC Blog NWAHEC Staff Practice Support Updates Practice Support Update Blog Medicare Payment Adjustments Apr 27, 2022 3:45:00 PM / by Practice Support Team Tweet If you are seeing changes in reimbursements for Medicare services, it may be related to the sequestration payment adjustments. In August 2021, each MIPS eligible clinician received a 2020 MIPS Final Score and 2022 payment adjustment information as part of their performance feedback. The 2022 MIPS payment adjustment, determined by the 2020 Final Score, will affect payments made for services in calendar year 2022. Three types of payment adjustments: Type of Payment Adjustment Impact to Payments in 2022 Positive Each covered professional service furnished in 2022 is reimbursed more than 100% - increase to paid amount Neutral Each covered professional service you furnish in 2022 is reimbursed 100% - no increase or decrease to paid amount Negative Each covered professional service you furnish in 2022 is reimbursed less than 100% - decrease to paid amount As a result of provisions and related to COVID-19 relief efforts, the Center for Medicare & Medicaid Services (CMS) allowed several flexibilities related to MIPS reporting in 2020 that affect 2022 payment adjustments. The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims: No payment adjustment through March 31, 2022 1% payment adjustment April 1 – June 30, 2022 2% payment adjustment beginning July 1, 2022 As an example, (if you are subject to the 1% negative payment adjustment), the total allowed payment for a particular service is $100 and the beneficiary has a 20% co-insurance, the beneficiary would be responsible for paying the provider the full $20 in co-insurance. The remaining 80% that is paid by Medicare would be reduced by 2% under the FY2018 sequestration order, or $1.60 in this example, resulting in a total Medicare payment of $78.40. In total, the provider would receive a payment of $98.40. This reduced payment is considered payment in full and the Medicare beneficiary is not expected to pay higher copayments to make up for the reduced Medicare payment. (source: Congressional Research Service https://sgp.fas.org/crs/misc/R45106.pdf ) Learn more in the Quality Payment Program 2022 Merit-based Incentive Payment System (MIPS) Payment Year Payment Adjustment User Guide Tags: MACRA, MIPS, practice management Written by Practice Support Team Practice Support Services Health care practices in North Carolina face many challenges. Our team of quality improvement coaches (QICs) have skills and expertise to support you in your transformation efforts. To learn more about Practice Support Click Here Apply for practice support services - fill out an application here Subscribe to Blog Updates Additional Resources: Connect With Us: Posts by Topic Medicaid Managed Care (73) COVID-19 (53) Medicaid (45) NCDHHS (32) Primary Care (32) Vaccines (17) Webinar (17) NCAHEC (16) Quality Improvement (12) Social Determinants of Health (12) Billing (11) MIPS (10) Pediatrics (10) nctracks (9) family medicine (8) Pediatric (7) advanced medical home (7) telehealth (7) NC Healthconnex (6) QPP (6) medicare (5) mental health (5) practice management (5) Fireside Chat Webinar (4) Preventive Care (4) Promoting Interoperability (4) care planning (4) coding (4) health equity (4) population health (4) reimbursement (4) rural health (4) EHR (3) Enduring (3) Geriatric (3) Healthy Opportunities (3) MACRA (3) NC HIEA (3) Vaccination (3) behavioral health (3) communication (3) glidepath (3) immunization (3) online learning (3) APM (2) CME (2) Grant (2) Nursing (2) Survey (2) Uninsured (2) alcohol use (2) cdc (2) clinical corner (2) depression (2) diabetes (2) falls (2) food insecurity (2) learning (2) monoclonal antibodies (2) nccare360 (2) nchiea (2) practice support (2) rural health centers (2) screening (2) APP (1) BCBS (1) CNA (1) CSRS (1) Case Management (1) Fetal Alcohol Spectrum Disorders (FASD) (1) Final Rule (1) Free and Charitable Clinics (1) Hardship Exception (1) Heart Health Now (1) Hepatitis C (1) ICD-10 (1) Keeping Kids Well (1) MOC IV (1) MVP (1) Medicine (1) NC Tracks (1) NCPHC (1) Nc Health Choice (1) Obstetrics (1) Office of Rural Health (1) PPE (1) PTSD (1) Perinatal (1) Pfizer (1) Pregnancy (1) Provider Enrollment (1) STD Update (1) STIs (1) STUN (1) Well-Child Care (1) access (1) antigen test (1) anxiety (1) breast cancer (1) care management (1) carolina access (1) claims (1) conference (1) continuing education (1) continuing education series (1) equity (1) fda (1) finance (1) financial assistance (1) food (1) health disparities (1) health literacy (1) healthy NC 2030 (1) home health (1) hosar (1) integrated care (1) leadership (1) management (1) mindfulness (1) oncology (1) outcomes (1) patient care (1) physicians (1) postpartum (1) public health (1) quality payment program (1) recovery (1) referral (1) research (1) rn refresher (1) support staff (1) technology (1) veterans (1) virtual (1) workforce (1) See all In Case You Missed It... Check Out These Recent Posts About Us Northwest AHEC and the Wake Forest School of Medicine have a collaborative partnership in offering certified continuing education to health professionals. Learn More Links Course Catalog Join Our Email List About Northwest AHEC Continuing Education Services Contact Support Contact Us ahecmktg@wakehealth.edu Medical Center Boulevard Winston-Salem, North Carolina Copyright 2022 | Designed by HubSpot
