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Have you noticed additional adjustments on your Medicare remittance advice this year? 

Payment Reductions?

I have received many questions from therapy providers this year regarding the new MPPR  (Multiple Procedure Payment Reduction) and what it means for their clinics.  

In a nutshell, Medicare is applying a reduction to the practice expense portion of the payment for a therapy procedure when more than one unit or procedure is provided to the same patient on the same date of service.  MPPR applies not only to multiple procedures, but also multiple units.

Full payment is made for the unit or procedure with the highest PE (practice expense) payment.  All subsequent units and/or procedures are paid at a reduced amount for the PE portion of the services.  The reduction is 20% for private practice/non-institutional settings and 25% for services furnished in an institutional setting.

Example of a therapy visit in a private practice setting in Texas:

 

Procedure                           Full fee                          Discounted

97110   x2                               $28.74(1st unit)            $26.12 (2nd unit)

97140   x1                                                                             $24.67

97035   x1                                                                            $10.79

                                      Total payment with MPPR      $90.32

 Without MPPR this year, the provider’s total payment would have been $96.20.  The net result is about a 6% overall reduction in expected payment for this particular set of services.

 Trailblazer offers a fee schedule for all states that includes both the undiscounted fee and the reduced therapy fees, already calculated. The APTA also offers an MPPR calculator to its members.

 Read more about MPPR on the CMS website.

 Therapy providers and their billing staff will want to run very specific practice management reports to estimate the impact these payment reductions will have on their businesses and come up with strategies to recoup any losses.

 Healthcare Reimbursement Services, LLC offers billing and consulting services to therapy providers around the country.  To see if we may be able to assist in your practice, give us a call at 888-211-1118 today!