A short time ago members reported to AHCA that it appeared that the Medicare Administrative Contractors (MACs) did not apply the Medicare Part B physician fee schedule (PFS) multiple procedure payment reduction (MPPR) edits properly to January 2021 date of service outpatient therapy claims resulting in overpayments. Some members provided claim remittance examples that we shared with the Centers for Medicare and Medicaid Services (CMS) to investigate. AHCA has received confirmation from CMS that they have identified the problem in the Fiscal Intermediary Shared System (FISS) and they are determining how long it will take to implement a fix. At this point CMS is expecting that mass adjustment will be done by the MACs once the fix is implemented and will not require further provider claim action.
AHCA will provide updates on implementation date of the fix when that information becomes available.
MPPR Background:
The MPPR policy required, effective April 1, 2013, a 50 percent reduction to be applied to the practice expense component of payment for the second and subsequent “always therapy” service(s) that are furnished to a single patient by a single provider on one date of service (including services furnished in different sessions or in different therapy disciplines) MLN Matters article
MM8206 provides an explanation and examples of application of the adjustment policy.
The MPPR Rate File 2021 lists those “always therapy” services subject to the MPPR policy and the reduced fee payment amounts for CY 2021 and is located in downloads section of the CMS
Therapy Services webpage.