The following announcement was released from the RBMA today regarding the CMS announcement regarding MPPR and further reimbursement reductions on services rendered by the same physician or group practice. The ACR and RBMA worked fervently, opposing this new policy, due to the impact these further cuts would place on American radiology professionals.
The Centers for Medicare & Medicaid Services (CMS) announced Friday that due to “operational limitations”, CMS’ contractors will not apply the Multiple Procedure Payment Reduction (MPPR) of 25 percent to the professional component (MPPR-PC) of subsequent CT, MRI, or ultrasound services to group practices in 2012. The 25 percent reduction, effective January 1, 2012, remains in effect for subsequent CT, MRI, and ultrasound services when furnished to the same patient, by the same physician, during the same session on the same day. The expansion of the MPPR-PC to group practices was opposed vigorously by the American College of Radiology (ACR). RBMA also opposed the policy and supported the ACR’s efforts in recent meetings with CMS.
In last month’s final rule for the 2012 Medicare physicians’ fee schedule, CMS announced its plans to expand its Multiple Procedure Payment Reduction (MPPR) policy to the professional component (PC) of CT, MRI, and ultrasound services when furnished to the same patient, by the same physician or group practice (emphasis added), in the same session on the same day. The procedure with the highest PC and technical component (TC) payments would be paid in full, but the PC payment of the subsequent procedure will be reduced by 25 percent.
CMS’ proposed rule for the 2012 Medicare physicians’ fee schedule included a 50 percent MPPR-PC but failed to mention it applying to physicians within the same practice.
By publishing the group practice provision only in the final rule, ACR argued that the agency violated public rulemaking and that the group practice provision was counter to current subspecialty radiology patient care. Bob Still, RBMA’s President-Elect, added that the provision would be difficult to implement for contractors and practices alike.
After this announcement on Friday, CMS released the following statement:
“The Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2011, are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames. The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk. We continue to urge Congress to take action to ensure these cuts do not take effect.”