The Centers for Medicare and Medicaid Services (CMS) recently made systems changes to address errors in payment amounts under the multiple procedure payment reduction policy (MPPR) that affected providers who submitted claims using UB-04 claim forms or the electronic version (837 institutional claims from rehabilitation agencies, outpatient hospitals, skilled nursing facilities (part B) etc). Specifically, providers who billed multiple dates of service on the same claim form for a patient were receiving full payment for only 1 unit of service out of all of the dates. Payment for all other units of service on the claim form was reduced by the 25% MPPR reduction amount. According to CMS, the problem has been corrected and payment for all claims submitted after February 7 should be accurate. CMS plans to adjust providers' claims that were paid in error. However, the details of how that adjustment will occur are still under development.
The MPPR policy, which became effective January 1, applies to outpatient physical, occupational, and speech-language pathology services provided to a patient that are paid under the Medicare fee schedule. Specifically, CMS will make full payment for the therapy service or unit with the highest practice expense value and reduce payment of the practice expense (PE) component by 20% in the office setting and 25% in institutional settings for the second and subsequent procedures or units of service furnished during the same day for the same patient. The MPPR would apply to therapy services when multiple therapy services are billed on the same date of service for the same patient by the same practitioner or facility under the same NPI, regardless of whether those therapy services are furnished in separate sessions. The reduction applies across the 3 therapy disciplines. Additional information explaining the MPPR policy is available on APTA's Web site.
If payment amounts appear to be incorrect for claims submitted after February 7, notify APTA at firstname.lastname@example.org.
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