MPPR Not Applied Correctly

Beginning in 2013, outpatient therapy services provided in CAH settings should be included in the beneficiary’s therapy cap and threshold total, using the amount that would be payable if the services were paid under the Medicare Physician Fee Schedule. Payments for outpatient hospital therapy services include a multiple procedure payment reduction when more than one unit or procedure is provided to the same patient on the same day by the same provider. Inadvertently, Medicare’s initial implementation of this provision updated the therapy cap and threshold total by the full fee schedule amount, without applying the multiple procedure payment reduction. The requirements of CR8278 correct how CAH claims update the therapy cap and threshold total.