2019 Payment Adjustment Information – How to Avoid Medicare Payment Penalties

2019 Payment Adjustment Information2019 Payment Adjustment Information – How To Avoid Medicare Payment Penalties With Basic Reporting.

The Medicare Quality Payment Program (QPP) is designed to potentially reward physicians for providing quality, high-value care to Medicare patients.

This is the first year physicians will need to report on quality measures under the new Quality Payment Program (QPP) from the Centers for Medicare and Medicaid Services (CMS). You can pick your pace of reporting for 2017 under the Merit-based Incentive Payment System (MIPS) of the QPP. Learn how to avoid a negative 4% payment adjustment in 2019 by reporting on one measure for one patient via CMS’ claim form before the end of 2017.

Instructions to Follow:

Steps 1 – Fill out a 1500 billing form as you normally would in boxes 1 through 20.
Steps 2 – Enter the patient’s diagnoses and procedure codes in box 21, as usual.
Steps 3 – Visit qpp.cms.gov/measures/quality to find the Quality Measure search tool. Search for the measure you’re reporting and note its three-digit quality ID number.
Steps 4 – Go to qpp.cms.gov/resources/education to find a ZIP file named “Quality Measure Specifications.” Download this file and unzip it on your computer.
Steps 5 – In the file you unzipped, open the “QPP_quality_measure_specifications” folder Use the quality ID code to find the claims document for the measure you’re reporting. In this document, find the Quality Data Code (QDC), for that measure.
Steps 6 – Go back to your 1500 billing form and enter the QDC code in box 24D.
Steps 7 – In box 24F, list a line-item charge of one cent ($0.01) for the QDC codes you entered in box 24D.
Steps 8 – Finish entering the information requested in boxes 25 through 33
Steps 9 – Submit your 1500 billing form to your Medicare Administrative Contractor.

Find an example of a completed sample form below and direct links to all of these CMS tools at:

Health Insurance Claim FormBox 21: Enter the applicable ICD-10 code for each diagnosis on its own line.
Box 24D: Enter QDC codes for appropriate measures.
Box 24E: Enter the diagnosis that is applicable to each service using the letter lines of the corresponding diagnosis in box 21.
Box 24F: QDC codes from box 24D must be accompanied by a line-item charge of $0.01 in box 24F.

Leave A Comment


Request a Free Quote

    Enter the Captcha: captcha