How to Understand your MIPS bonus?

Did you participate in MIPS in 2020? Did you score well? If you answered yes to both, at first glance it might look like you are losing money from Medicare, but once you understand how MIPS is processed, you will see how your bonus is calculated.

SvcLr	Procedure	Med	Unit	Charges	Allowed	Paid	Adjustment
1	97016	GP	1	27.04	9.13	7.34	-0.11 (CO- 144) -0.07 (CO- 253) 15.26 (CO- 45) 2.65 (CO- 59) 1.83 (PR- 2)
2	97110	GP	2	88.82	45.40	36.50	-0.55 (CO- 144) 0.37 (CO- 253) 30.20 (CO- 45) 13.22 (CO- 59) 9.08 (PR- 2)
3	97530	GP	1	48.52	36.90	29.67	-0.45 (CO- 144) 0.30 (CO- 253) 11.62 (CO- 45) 7.38 (PR- 2)
Total				$164.38	$91.43	$73.51	$90.87

If the above image looks both familiar and confusing, we are here to help. Included below is the glossary that Medicare sends with their payments. “CO” stands for “Contractual Obligations”. This is also known as the write off. Your write off amount is being decreased by the listed amount, and then added to your payment. The “144” after the CO specifies, “Incentive adjustment, e.g. preferred product/service.” This CO-144 is your MIPS adjustment. If the amount is negative, you are getting your positive payment adjustment. Congratulations!

Glossary

PR: Patient Responsibility
OA: Other Adjustments
CR: Correction and Reversals
CO: Contractual Obligations
PI: Payor Initiated Reductions

144: Incentive adjustment, eg preferred product/service.

The MIPS process is automated with Systems4PT. You can rest easy knowing that if you are required to submit MIPS, our system has your back. Our MIPS automation is included with your normal pricing of the system! No addition fees, especially for things that Medicare requires you to do. We would love to show you how it all works.