In Coding
Apr 5th, 2018
The multiple procedure payment reduction (MPPR) means that if a healthcare provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure. The reason is explained in Chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: Most medical and surgical ...
Aug 26th, 2016
Effective Jan. 1, 2017, Medicare administrative contractors (MACs) will reimburse physicians, providers, and clinical diagnostic laboratories considerably more for the professional component (PC) of certain diagnostic imaging procedures than in years past. When Less is More Since 2012, MACs make full payment for the PC of the highest-priced procedure, and apply a Multiple Procedure Payment ...
By Edie Hamilton, CPC, CPC-I Reducing indicator, modifier, and calculation confusion will safeguard reimbursement. The Medicare Physician Fee Schedule (MPFS) was introduced in 1992 to replace the “reasonable and customary” payment methodology standard for physician services. Under the MPFS, payment has been based on relative value units (RVUs), which represent the value of work or ...
Jul 1st, 2013
Cardiovascular and ophthalmology technical service providers will feel the penny pinch. By Uma Nachiappan, CPC, CCS Effective Jan. 1, 2013, the Centers for Medicare & Medicaid Services (CMS) expanded its Multiple Procedure Payment Reduction (MPPR) policy to cover diagnostic cardiovascular and ophthalmology procedures. Providers rendering the technical component (TC) of such services can expect ...
In Billing
Jun 26th, 2013
by Nancy Clark, CPC, CPC-I Effective January 2013, reduced payment has been made for specific ophthalmologic diagnostic codes. These codes are identified in the Medicare Physician Fee Schedule with the new Multiple Procedure value of “7.” Diagnostic ophthalmology services subject to MPPR include (code listed with short descriptor): 76510 Ophth us b & quant a ...