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  • CMS Makes Official Statement on MPPR 'Fixes'

    The Centers for Medicare and Medicaid Services (CMS) recently issued an official statement regarding the problems associated with payment under the multiple procedure payment reduction (MPPR) policy. As reported February 18 in News Now, CMS made system changes on February 7 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.

    In its recent statement, CMS says that it also has learned that the Fiscal Intermediary Shared System was using a rate file which contains rates that reflect a 20% reduction rather than the 25% reduction that is appropriate for institutional claims. As a result of this error, all outpatient  therapy services billed by providers who use UB-04 claim forms or 837I with dates of service on or after January 1 have been paid incorrect amounts for codes subject to the MPPR policy.

    Medicare contractors will install a corrected rate file in early May. CMS has instructed Medicare contractors to adjust claims that were paid incorrectly no later than June 30.

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