Wiki Utilizing MSR on outpatient facility claims

[0018503Mccabe]

Hello. I am new to the AAPC so I apologize if I am going about this all wrong.

Does anyone have knowledge of a policy that supports the use of MSR (reductions) on outpatient facility claims. This has been a recent hot topic to us locally and I am looking for all the knowledge I can gain.

Thank you!

 

[thomas7331]

Medicare does apply multiple procedure reductions to some codes on outpatient facility claims under the OPPS system. Pricing of claims under OPPS is rather complex, but codes that are designated as status 'T' that are not combined into a comprehensive case rate (APC) of another procedure are subject to multiple procedure reductions, similar to the way multiple procedures are applied on physician claims. For non-Medicare payers, this would be driven by payer policy and provider contracts (the way in which multiple procedure reductions are applied is usually spelled out clearly in the facility contracts with each payer). In my experience most commercial payers do apply multiple procedure reduction to outpatient facility claims.

 

[0018503Mccabe]

Tom,

Would you have a link to where I can locate information on the reductions/pricing methodologies Medicare uses in OPPS? IE where they call out status T codes? It would be greatly appreciated. I am attempting to work on this with our reimbursement staff.

Melissa McCabe, CCS

Medicare does apply multiple procedure reductions to some codes on outpatient facility claims under the OPPS system. Pricing of claims under OPPS is rather complex, but codes that are designated as status 'T' that are not combined into a comprehensive case rate (APC) of another procedure are subject to multiple procedure reductions, similar to the way multiple procedures are applied on physician claims. For non-Medicare payers, this would be driven by payer policy and provider contracts (the way in which multiple procedure reductions are applied is usually spelled out clearly in the facility contracts with each payer). In my experience most commercial payers do apply multiple procedure reduction to outpatient facility claims.