Understanding your Remittance Advice for Merit-Based Incentive Payment System Adjustments

National Government Services has seen an increase in invalid overpayment requests related to the MIPS program. MIPS is part of the QPP that determines Medicare performance-based payment adjustments.

The Quality Payment Program is part of the MACRA and includes two tracks – Advanced APM and the MIPS. MIPS replaces the Sustainable Growth Rate formula and streamlines the following three “Legacy Programs”:

• EHR (Meaningful Use)
• PQRS
• VM

Using a composite performance score, eligible clinicians may receive a MIPS payment bonus, a payment penalty or no payment adjustment; a MIPS adjustment can be positive or negative. It’s important to review your RA to determine what the payment adjustment was for. CARC/RARC codes for MIPS performance-based payment adjustments are:

• For a positive adjustment: Group code CO, CARC 144 and the amount and RARC N807
• For a negative adjustment: Group Code CO, CARC 237 and the amount and RARC N807

Visit the CMS QPP website for participation, reporting, and performance category requirements.

Questions related to the QPP can be directed to CMS:

• Monday- Friday 8:00 a.m.-8:00 p.m. ET

  • 866-288-8292 (TRS: 711) when dialing 711, you will automatically be connected to a TRS Communications Assistant who will relay your conversation to the help desk agent with strict confidentiality.
• Email: QPP@cms.hhs.gov

Posted 8/1/2022