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Humana Updates Its MIPS Payment Policy

Medical Billing

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The Merit-based Incentive Payment System (MIPS) is a program that evaluates and rewards participating providers based on data reported in four performance categories: Quality, Promoting Interoperability, Cost, and Improvement Activities.

Starting in June 2019, Humana Medicare Advantage plans will use MIPS payment adjustment rates when reimbursing out-of-network clinicians that participate in MIPS for covered professional services. MIPS-eligible claims for services dates beginning January 1, 2019, that were processed before June 2019 will be reprocessed. The appropriate MIPS payment adjustment will then be retroactively applied to these claims.

For more information about MIPS and the Quality Payment Program, follow the link to our overview article, QPP Final Rule 2019 or visit For questions about Humana’s policy update, call Humana’s customer service at 1-800-457-4708.

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