CMS incorrectly applying 2019 MIPS adjustments to Part B drugs

A number of practices have been seeing their 2019 MIPS payment adjustments come in in the past few days.  Some Medicare Administrative Contractors (MACs) are making adjustments on payments for Part B drugs, which is currently forbidden under Federal law.  The technical corrections to MACRA promulgated in the Bipartisan Budget Act of 2018 (February 9, 2018) that gave CMS more control over the process also changed the language in the law as it applied to penalties or bonuses related to “items or services”.  This change from “items or services” to “covered professional services” is significant; it means that if a provider or group is eligible for a bonus or penalty from MIPS, it will not affect future years’ Part B drug payments in any way.

Your diagnostic tests, surgeries, and exams paid by Part B are still subject to the positive or negative MIPS adjustments since they are “covered professional services” but paid Part B drugs are excluded in this change from any sort of MIPS adjustment (sequestration remains in play).

The professional societies are in communication with CMS and we are awaiting CMS’ response.   It is likely that a fix will be implemented and there will be “reverse adjustments” on the paid Part B drugs portion at some future date.

We are happy to assist providers and groups in any way with other topics including MIPS in general or 2018 MIPS attestations, as well as proper code selection, chart reviews, payer action questions – please contact us.  We can also provide training on these or other subjects.  You can reach us via the link to our main webpage or at the phone number below.  You can also download our “App”, Corcoran 24/7, which can be separately accessed via one of the links below.

www.corcoranccg.com (800) 399-6565

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