APR 04, 2019
UPDATE: CMS Contractors Take Steps to Recoup Erroneous Part B Drug Payments
The Academy has new information on a nationwide coding error, in which Medicare Administrative Contractors are incorrectly applying Merit-Based Incentive Payment System penalties and bonuses to Part B drug payments to physicians.
The Centers for Medicare & Medicaid Services tells us that adjustment requests have now all gone out to practices. Some MACs are requesting practices send in refunds. Additionally, some MACs are recouping overpayments minus the sequestration amount but are not communicating this detail to practices.
For example, the sequestration deduction that Novitas originally took from practices was applied to the actual paid amount for both the drug and the service (80% of allowable, plus the MIPS incentive). Now that Novitas is taking back its incentive money from the drug, it is also decreasing the sequestration amount applied by roughly 1.98%. This leaves a small amount left to the practice.
The original error was that sequestration was applied to the drug payment incentive along with the intravitreal injection service. This should not have happened, since the drugs were never supposed to be part of the equation.