CMS Announcement Regarding the Multiple Procedure Payment Reduction (MPPR) Policy
CMS distributed the following announcement regarding claims processing for the recently-implemented multiple procedure payment reduction (MPPR) policy for outpatient therapy. AOTA will continue to monitor MPPR implementation, and invites you to email us at firstname.lastname@example.org with any billing/payment problems you have encountered.
Corrections to Payments for Certain Multiple Procedure Payment Reduction (MPPR) Claims
It has been brought to the attention of the Centers for Medicare & Medicaid Services (CMS) that the Fiscal Intermediary Shared System (FISS) is taking the Multiple Procedure Payment Reduction on claims regardless of whether the services were provided on the same day. As a result of this coding error, any therapy claims with dates of service on or after January 1, 2011, processed from January 3, 2011 through February 6, 2011, with one of the specified therapy codes in Change Request (CR) 7050 were processed incorrectly.
System changes were successfully implemented on February 7, 2001, and the CMS has instructed Medicare contractors to adjust claims that processed incorrectly.
CMS has also learned that the FISS 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 therapy services subject to the MPPR with dates of service on or after January 1, 2011, have been paid incorrect amounts.
Medicare contractors will install a corrected rate file in early May, and the CMS has instructed Medicare contractors to adjust claims that were paid incorrectly no later than June 30, 2011.