These frequently asked questions (FAQs) were developed to answer questions about the recent update to our Multiple Procedure Payment Reduction (MPPR) policy.
1.
What is the Multiple Procedure Payment Reduction policy update?
Independence Blue Cross (IBX) and Independence Administrators are making changes to the Multiple Procedure Payment Reduction (MPPR) policy to align our reimbursement position with the Centers for Medicare & Medicaid Services (CMS) MPPR Guidelines for Physical, Occupational, and Speech Therapy Services (i.e., Always Therapy Services).
As of July 1, 2024, the updated policy is effective and MPPR will apply when either one or multiple units of therapy services are provided to the same individual on the same day (see the hierarchy for MPPR guidelines below):
- 100 percent of the facility provider's applicable contracted rate of one unit of the procedure code with the highest total allowance is eligible for reimbursement consideration.
- Each subsequent unit or procedure code is eligible for reimbursement at 50 percent of the provider's applicable contracted rate.
2.
What providers are impacted by the policy update?
This policy update applies to outpatient facility providers billing on a CMS-1450 (UB-04) claim form, or the equivalent 837I claim form, for IBX and Independence Administrators members.
3.
Why is the policy being updated now?
We are moving our business to a new claims processing system and can align our reimbursement position with CMS on the new platform. The transition to the next generation platform, which will continue through 2025, will help us efficiently deliver new and innovative products and services. The new system applies MPPR in alignment with CMS.
4.
How will this update affect claims processing?
The way this policy update is applied may vary based on the claims processing system being used. This means that outpatient facility providers may see a difference in claims payment when the policy is updated on the new platform.
5.
The amount of reimbursement I receive may be impacted by this; can I renegotiate my rates?
We recognize that this may have an impact on what you are reimbursed. However, this is a standard policy update, and rates cannot be re-negotiated.
6. Will this affect patient care for IBX and
Independence Administrators members?
No, providers should continue to provide the appropriate level of care.