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Written by: Darlene D'Altorio-Jones (1959-2015) on Tuesday, January 11, 2011 Posted in: Outpatient Rehab

MPPR – Multiple Procedure Payment Reduction is here!

Multiple times a year, CMS releases newsworthy instructions that change life as we know it; and your bottom line is about to take a hit.  On January 3, 2011, CMS released MLN Matters MM7050 (revised), which is one such publication that is a must read for outpatient therapy providers.

If you practice therapy in an outpatient setting and are paid under the Medicare Physician Fee Schedule (MPFS), you are about to experience reduced payments in your practice expense (PE) portion of fees. Recall paid fees are apportioned relative value units consisting of three different expenses: 1) work 2) malpractice and 3) practice expense totaling a final figure Medicare pays for each specific HCPCS code (called procedures and described as timed or untimed ‘units’, specific to your geographic region.)

When more than one service on an institutional claim meets the criteria of multiple procedure on the same date of service, whether performed by same or different disciplines, contractors will pay the full fee schedule payment for the line with the highest value. First unit and reduced PE portions for all other units provided on the same day.
A complete list of 44 codes can be found in Transmittal 826 released 12/21/2010. You will know when your bill has been adjusted because contractors will use the code “CO” contractual obligation, on the remittance advice notices when MPPR methodology was applied.

In the 28 years I have practiced physical therapy, most significant change in practice has been witnessed after regulatory payment guidelines were introduced. DRG, PPS, Pay for Performance, just to name a few. How do you believe this will affect the way we practice?

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