MPPR Update

[Guest guest]

From CMS:

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.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Upcoming audio conference will be " Understanding Time-Based CPT Codes: A

Comprehensive Review " on May 18, 2011.