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).


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.


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.


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.

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