MPPR questions

[Guest guest]

Hi group,

Ok, so I've read the 35 or so pages in the final rule describing MPPR

changes, as have some of our compliance folks. My staff and I have some

questions- I'll present in the form of scenarios. Thanks in advance for

your help and clarification. We realize that the reduction is now down

to 20% of the PE...

1) Let's say we bill two units of 97110 in one treatment session. Our

assumption is that the 2nd unit's reimbursement will drop 20% only on

the practice expense. Correct? By the way, we find the calculation for

the PE quite befuddling...

2) We bill two units of 97110 and one unit of 97140 in a treatment

session. Is the reimbursement for both the 2nd unit of 97110 and the

unit of 97140 dropped by 20% as compared to the first unit? One of my

therapists was under the impression that the the 3rd unit's 20%

reduction (PE) was based on the already-reduced *2nd* unit and not the

first.

3) A patient receives ST, OT, and PT evaluations in succession in one

day, in that order. Is ST considered the first service that is fully

reimbursed and all subsequent units billed on that day afterwards

subject to the MPPR?

Thanks for helping clear up the confusion.

Meryl W. Freeman, MS PT

Manager, Outpatient Rehab

Rex Healthcare

(office)

(cell)

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