on December 19, 2011 |
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Topics: Reimbursement, Finance, Medicaid, Medicare, Imaging, Service Lines, Payer and Regulatory Policy, Market Trends, Strategy
Stephanie Krent, Imaging Performance Partnership
Earlier today, the Centers for Medicare and Medicaid Services (CMS) announced a revision of the Multiple Procedure Payment Reduction (MPPR) rules. For 2012, there will be no payment reduction applied to the professional component of imaging services performed on the same patient in the same session but read by different physicians in the same practice.
Why now?
The news comes on the heels of
sustained lobbying from the American College of Radiology (ACR). According to John Patti, Chairman of the ACR Board of Chancellors, over 7,000 ACR members contacted CMS about the MPPR expansion. CMS announced that “operational limitations” led to the modified rule, and noted that the 25% reduction to the professional component of imaging services will still go into effect for exams conducted in the same session and read by the same physician.
Evolution of the MPPR
The MPPR has traditionally applied to the technical component of advanced imaging procedures, including CT, MRI, and ultrasound. In these instances, full payment is made to the highest paid procedure, and 50% reimbursement is paid for the second and subsequent exams. In June of 2011, MedPAC suggested that CMS expand the MPPR to the professional component of advanced imaging services as well.
Despite significant criticism, CMS incorporated MedPAC’s suggestion into the proposed rules for the 2012 physician fee schedule. In the proposed rule, CMS would decrease professional payment by 50% for second and subsequent imaging services conducted on the same patient, in the same session, and interpreted by the same physician.
The 2012 physician fee schedule final rules, however, painted a slightly different picture. CMS announced that it would only decrease reimbursement for second and subsequent services by 25%. However, the final rules also clarified that CMS will apply the MPPR for services conducted in the same session and interpreted either by the same practitioner or by any practitioners in the same group practice.
As the rule stands now, CMS will apply the 25% payment reduction when multiple services are furnished to the same patient, in the same session, and interpreted by the same practitioner.
Legislative Efforts to Block the MPPR
While the ACR has publicly taken credit for CMS’ modified rule, it maintained its continued efforts to completely block the expansion of the MPPR. The ACR championed
H.R. 3269, a proposed bill in the House of Representatives. Sponsored by Pete Olsen (R-TX), the bill would eliminate the application of the MPPR to the professional component of imaging services “unless the reduction is based on the data, analysis, and conclusions of a study completed by… a national medical specialty society expert in the field of diagnostic imaging services (such as the American College of Radiology).” According the ACR, although the bill is unlikely to be passed in 2011, it is now co-sponsored by 150 members of Congress.
For more on the 2012 physician fee schedule and upcoming changes to imaging reimbursement, please consult the Partnership’s
Imaging Payment Update for 2012.
