Reductions to Medicare Part B Physician Fee Screen - Multiple Procedure Payment Reduction (MPPR)
As part of ongoing efforts to control costs, CMS has implemented a Multiple Procedure Payment Reduction (MPPR) for certain procedure codes related to therapy. You may have heard about a 25% reduction to Medicare Part B for therapy. This is partially true. The reduction or MPPR is not a reduction to the entire amount of the fee schedule or an across the board reduction to all CPT/HCPC codes billed for therapy. Rather, it is a reduction to one component of the fee schedule amount.
Based on information we are receiving, it appears that this MPPR adjustment will reduce most Skilled Nursing Facility's Medicare Part-B payments for Therapy by about 5%.
What Exactly is Being Adjusted?
The Fee Schedule amounts are arrived at using different factors (the rate you see is made up of different pieces) including:
- Work Component
- Practice Experience Component
- Malpractice Component
We mention this because only one of these factors is being adjusted, the Practice Experience (PE) component. This Practice Experience or "PE" component is being reduced by 25% for each unit performed after the first unit on a particular day.
Not all therapy codes are reduced. Only 46 of the over 100 codes are on the list for the MPPR. Unfortunately these 46 make up about 90% of what SNF therapists typically bill for. There is a list of affected codes at the end of this article.
All in all, the reduction to the SNF's Medicare Part-B revenue is expected to be about 5%.
You Need To Take It Unit By Unit
You will get paid full price for the first unit of therapy performed on any given day, BUT, all additional units of therapy (even if the next unit is an additional unit of the same CPT/HCPCS code) performed that day will be reduced under the MPPR. The following is an excerpt from the Medline Matters article published by CMS:
"Many therapy services are time-based codes, i.e., multiple units may be billed for a single procedure. The Centers for Medicare & Medicaid Services (CMS) is applying a MPPR to the practice expense payment when more than one unit or procedure is provided to the same patient on the same day, i.e., the MPPR applies to multiple units as well as multiple procedures. Full payment is made for the unit or procedure with the highest PE payment. For subsequent units and procedures, furnished to the same patient on the same day, full payment is made for work and malpractice and 80 percent payment for the PE for services furnished in office settings and other non-institutional settings and at 75 percent payment for the PE services furnished in institutional settings."
You Need To Take It Day by Day
The MPPR reduction calls for a reduction in the PE component when more than one unit of service is billed in a day, whether that is two units of the same service, multiple services by the same discipline or services of multiple disciplines (PT, OT, SLP) in the same day. 100% of the PE is paid for the first unit (the unit with the highest PE). The PE components for all other units billed that day are reduced by 25%.
Something To Consider - If it is possible to avoid multiple units / disciplines on the same day the number of units being reduced will be lower.
You Need Talk With Your Rehab Team
The MPPR may not be the most significant issue you have to deal with, but it is a reduction to your revenue none the less. We advise that you talk with your rehab team about the following:
Strategies to avoid reductions - As discussed above if you can avoid multiple units on the same day you can lower the overall reduction.
The amount you are paying for Part-B services - If you are paying a rehab provider based on a percentage of the Medicare Part-B "Fee Schedule" amount, you need to understand you will receive less than the publishedfee schedule amount for reduced units. Please review the contract and make the appropriate changes to ensure you are paying the correct amounts for Part-B services.
Resources & References - The CMS rule on this was published in the Federal Register on July 13, 2010. A period of comments followed with updates in the November 29, 2010 Federal Register (Vol. 75, No. 228). The final rule was published December 21, 2010 both as Transmittal 826 and MedLearn article MM5070.
Should you have any questions or need further clarification please contact us at Axiom Healthcare Group
- Mike Lesnick
714-594-5720
mikel@axiomhc.com
- Ron Wall
909-472-8900
ronw@axiomhc.com
Visit our website at: www.axiomhc.com
Codes Impacted By The MPPR
"Always Therapy" Services Proposed as Subject to the CY 2011 MPPR Policy
| CPT/HCPCS Code | Short Descriptor |
|---|---|
| 92506 | Speech/hearing evaluation |
| 92507 | Speech/hearing therapy |
| 92508 | Speech/hearing therapy |
| 92526 | Oral function therapy |
| 92597 | Oral speech device eval |
| 92607 | Ex for speech device rx, 1hr |
| 92608 | Ex for speech device rx addl |
| 92609 | Use of speech device service |
| 96125 | Cognitive test by hc pro |
| 97001 | Pt evaluation |
| 97002 | Pt re-evaluation |
| 97003 | Ot evaluation |
| 97004 | Ot re-evaluation |
| 97010 | Hot or cold packs therapy |
| 97012 | Mechanical traction therapy |
| 97016 | Vasopneumatic device therapy |
| 97018 | Paraffin bath therapy |
| 97022 | Whirlpool therapy |
| 97024 | Diathermy eg, microwave |
| 97026 | Infrared therapy |
| 97028 | Ultraviolet therapy |
| 97032 | Electrical stimulation |
| 97033 | Electric current therapy |
| 97034 | Contrast bath therapy |
| 97035 | Ultrasound therapy |
| 97036 | Hydrotherapy |
| 97110 | Therapeutic exercises |
| 97112 | Neuromuscular reeducation |
| 97113 | Aquatic therapy/exercises |
| 97116 | Gait training therapy |
| 97124 | Massage therapy |
| 97140 | Manual therapy |
| 97150 | Group therapeutic procedures |
| 97530 | Therapeutic activities |
| 97533 | Sensory integration |
| 97535 | Self care mngment training |
| 97537 | Community/work reintegration |
| 97542 | Wheelchair mngment training |
| 97750 | Physical performance test |
| 97755 | Assistive technology assess |
| 97760 | Orthotic mgmt and training |
| 97761 | Prosthetic training |
| 97762 | C/o for orthotic/prosth use |
| G0281 | Elec stim unattend for press |
| G0283 | Elec stim other than wound |
| G0329 | Electromagntic tx for ulcers |