Check Your MPPR Claims for Errors

The Centers for Medicare & Medicaid Services (CMS) notified providers in a Provider Partnership email, April 14, that the Fiscal Intermediary Shared System (FISS) was using a rate file that reflects a 20 percent multiple procedure payment reduction (MPPR) that is appropriate for non-institutional claims, rather than the 25 percent 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 Jan. 1 have been incorrectly paid. CMS has instructed Medicare contractors to install a corrected rate file in early May, and to adjust claims that were paid incorrectly no later than June 30.

CMS also has learned that the FISS was taking the MPPR 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 Jan. 1, 2011, processed from Jan. 3 through Feb. 6, with one of the specified therapy codes in Change Request (CR) 7050 were processed incorrectly.

System changes were successfully implemented on Feb. 7, and CMS has instructed Medicare contractors to adjust claims that processed incorrectly.

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