Hot Topics: Multiple Procedure Payment Reduction (MPPR)

What is MPPR?

Medicare applies a multiple procedure payment reduction (MPPR) to the practice expense component of certain “always therapy” services. Since April 1, 2013, this MPPR rate has been 50 percent for both practitioner/office and institutional settings.

What is the goal of MPPR and why did Medicare institute it?

The goal of MPPR is to curb costs. MPPR reduces payment for practice expense to 50 percent for the second and subsequent therapy procedures furnished to the same patient on the same day, even if they are in one or multiple disciplines (PT, OT, SP).

Does the amount Medicare pays count towards the therapy caps and thresholds?

Yes. The amount Medicare pays is what is counted toward the $2010 therapy caps and the $3700 threshold in 2018.

How does MPPR impact payments?

MPPR reduces Medicare payment for practice expense on 2nd and subsequent procedures to the same patient on the same day. The APTA has estimated that the 50% MPPR policy may reduce Medicare payments by approximately 6-7 percent for the typical therapy practice.

Does this mean that MPPR applies to all therapy services on the same day?

Yes. 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).

What can therapy practices do to help minimize the financial impact from MPPR?

MPPR has significant impact on your practice’s financial health. To avoid being caught by a financial surprise, you need to:

• Know when to apply KX modifiers
• Document defensibly and supply appropriate documentation

• Understand when you are reaching the $3700 threshold
• Be able to forecast the impact of MPPR on cash flow and revenues

How can Clinicient Insight help therapists with MPPR?

Clinicient provides the proven best practices, automated processes, coding rules and reporting tools all in one system to stay on top of MPPR and other Medicare programs. With Clinicient Insight you can:

Simplify 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 $3700 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.

Avoid Complex Math and 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.

Understand the Potential Impact of MPPR

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