MU: Is your organization receiving negative adjustments from the CMS Quality and MU programs?
April 20, 2016
Written by Patty Kosednar
You may want to review your Medicare payments for adjustment codes from CMS for the Medicare Part B charges to determine if your organization is affected.
We recommend reading CMS How Do I Avoid the 2016 Medicare Quality Reporting Payment Adjustments? You will learn about the 2016 negative or downward payment adjustments for Physician Quality Reporting System (PQRS), Medicare EHR Incentive program, and Value Based Payment Modifier (VM).
How will you know if your claim was adjusted? See page 6 in How Do I Avoid the 2016 Medicare Quality Reporting Payment Adjustments?
A CARC, Claim adjustment Reason Code and remittance advice remark code (RARC) are code sets used to report payment adjustments on an EPs or groups practice’s Remittance Advice. Both of these code sets are updated three times a year.
The PQRS, EHR Incentive program and VM currently use CARC 237 – Legislated/Regulatory penalty, to designate when a negative or downward payment adjustment will be applied. 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) in combination with the following RARC’s:
- PQRS-N699-Payment adjusted based on the PQRS Incentive Program
- EHR-N700-Payment adjusted based on the EHR Incentive Program
- VBM-N701-Payment adjusted based on the Value-Based Payment Modifier
Leave a reply, ask a question or share information using the “Leave a Reply” section below, or email Patty Kosednar directly with your questions or comments.
Subscribe to the HTS Meaningful Use Blog
Subscribe
See a list of upcoming webinars
Check out any webinars you missed
Leave a Reply