MACRA Quality Payment Program
The Quality Payment Program began in January of 2017. Final scores and feedback for physicians who were not exempt from the Merit-based Incentive Payment System (MIPS) during the 2017 performance year are now available through the QPP website. Those physicians received their MIPS payment adjustments in January of 2019. The physician community recently made 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 have shared 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.
In early February, 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.”
The Centers for Medicare and Medicaid Services (CMS) released emergency regulations for individual clinicians affected by natural disasters, including Hurricanes Harvey, Irma, Maria, and Nate and the California wildfires, during 2017. Individual clinicians who practice in certain affected regions will automatically be exempt from reporting measures or activities for 2017 and will not receive a negative payment adjustment in payment year 2019. Group practices are not eligible for this accommodation. Visit the QPP website for more information about the emergency regulations and eligibility requirements for those affected by Hurricane Florence, Hurricane Michael, and the California Wildfires during the 2018 performance year. When they released requirements for the 2019 performance year, CMS indicated that this policy would remain the same for the 2019 performance year.