Medicare has added a payment adjustment for MIPS on claims with a date of service of 2019 with an actual payment amount.  This will be represented by a “remittance advice remark code (N807)” and accompanied by either a claim adjustment reason code of either CO-144(incentive) or CO-237(penalty).

ISSUE:

The 835 posting routine did not contemplate the posting of the MIPS payment adjustment transaction on claims with dates of service 2019(100% applied to deductible is not an issue).  There is a possibility that patient balance is not correct on the referenced postings.

RESOLUTION:

ACS has made a change to the 835 electronic posting routine to account for the MIPS transactions.  The appropriate patient balance is now  accounted for in the posting routine.

ACTION NEEDED BY PROVIDERS OFFICE:

We recommend an audit of claims paid for dates of service of 2019 with an actual payment, you may need to adjust the disallowance to get to an accurate patient balance.