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.
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).
Yes. The amount Medicare pays is what is counted toward the $2010 therapy caps and the $3700 threshold in 2018.
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.
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).
MPPR has significant impact on your practice’s financial health. To avoid being caught by a financial surprise, you need to:
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:
Clinicient’s single system delivers the end-to-end processes, controls and visibility to manage MPPR, other Medicare requirements and maximize reimbursements.
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.
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.
Revenue reporting tools help you forecast the impact of MPPR on cash flow and revenues.