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Expansion of the multiple procedure payment reduction

HIM Connection, January 10, 2012

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CMS plans to expand the Multiple Procedure Payment Reduction (MPPR) for 2012. While the increase is not as extensive as CMS originally proposed, it does indicate the potential for further expansion in the coming years. Medicare has a longstanding policy to reduce payment by 50% for the second and subsequent surgical procedures furnished to the same patient by the same physician on the same day.

For January 1, 2012, CMS proposed to expand the MPPR to include advanced imaging services. In the proposed rule, CMS also planned to extend the reduction of 50% to include the professional component (PC) based on expected efficiencies by the physicians when providing these services during the same session. Commenters argued that technological advances in imaging require radiologists to review more images with increased complexity than when CMS originally valued the services.

In response, CMS stated it believes that some level of duplication exists in the PC for second and subsequent advanced imaging services, citing in particular:

• Significant duplication in the pre-service work, which consists of reviewing patient history and any prior imaging studies, and determining the protocol and communicating that protocol with technologists
• Significant duplication in the post-service work, which almost always consists of reviewing and signing a final report and discussing findings with the referring physician
• Moderate efficiencies in intra-service work, specifically, supervising contrast (where appropriate), interpreting the examination and comparing it to other studies, and dictating the report for the medical record

However, in acknowledgement of the commenters’ argument, CMS decided to apply only a 25% reduction to the PC rather than the originally proposed 50% reduction.

Read more on HCPro’s Medicare Find blog.

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