Therapist and laughing client
Avoid financial surprises from Medicare MPPR.

Medicare MPPR Requirements for Physical Therapy - Clinicient

The APTA estimates the 50% MPPR policy will reduce Medicare payments by approximately 6-7 percent for the typical therapy practice. To escape being caught by a nasty financial surprise, you need to accurately calculate Medicare MPPR and have visibility into how MPPR is impacting your cash flow and revenues. That’s where Clinicient helps with the proven processes, reporting tools and insight so you:

  • Know when to apply KX modifiers
  • Document defensibly and supply appropriate documentation
  • Understand when you are reaching the $3700 Manual Medical Review threshold
  • Get paid the maximum amount you’re allowed

The results? With Clinicient, you’re notified—and prepared—to keep on top of Medicare therapy caps, manual medical review and other requirements.

Medicare MPPR Capabilities

    Simplified Compliance

    Clinicient’s single system delivers the end-to-end processes, controls and visibility to manage MPPR, other Medicare requirements and maximize reimbursements.

    Know Where Things Stand

    You know exactly when to apply KX modifiers and when a patient is near the MMR threshold. You’ll also see any discrepancies between what you expected to get paid and what was allowed so you can work claims to get paid the full amount you’re owed.

    No Complex Math or Guesswork

    Clinicient automatically calculates MPPR based on a built-in RVU table. It also provides therapy cap and MMR tracking, alerting and management based on MPPR calculations.

    Insight into MPPR Impact

    Revenue reporting tools help you forecast the impact of MPPR on cash flow and revenues.

    MPPR requirements

    As of April 1, 2013, Medicare’s multiple procedure payment reduction (MPPR) reduced payment for practice expense from 50 percent for the second and subsequent therapy procedures furnished to the same patient on the same day even if they are in multiple disciplines (PT, OT, SP). The amount Medicare pays is what is counted toward the $1960 therapy caps and the $3700 thresholds.

    Multiple Procedure Payment Reduction (MPPR) Effective April 1, 2013

    MPPR reduces Medicare payment for practice expense on 2nd and subsequent procedures to the same patient on the same day.

    1st Unit
    • Full Payment for Practice Expense
    • Full Payment for Work
    • Full Payment for Malpractice
    2nd Unit
    • 50% Payment for Practice Expense
    • Full Payment for Work
    • Full Payment for Malpractice
    3rd Unit
    • 50% Payment for Practice Expense
    • Full Payment for Work
    • Full Payment for Malpractice

    MPPR applies to all therapy services for a patient on the same day, even if they are in one or multiple disciplines (PT, OT, SP).

    Jerry Henderson PT

    Learn how Clinicient can help you simplify manual medical review with Jerry Henderson, PT.