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CMS Announces It Inappropriately Applied Part B Drug Reimbursements to 2019 MIPS Payment Adjustments and Releases FAQ; Agency Will Adjust Impacted Claims

As we reported last week, some practices have been experiencing MIPS payment adjustments on Part B drug reimbursements and ASCRS has alerted CMS. In response, CMS has announced that it made an error in the implementation of the 2019 MIPS payment adjustment by incorrectly applying payments to Part B drugs and other non-physician services billed by physicians. CMS will release the following FAQ on the issue:

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

A: On Feb. 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 Centers 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.

We will keep you updated.

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