Home > Legal Updates > Elizabeth Sullivan was featured in "CMS Proposed Rule Expands Multiple Procedure Payment Reductions to Professional Component…," published by RBMA

Elizabeth Sullivan was featured in "CMS Proposed Rule Expands Multiple Procedure Payment Reductions to Professional Component…," published by RBMA

Elizabeth Sullivan was featured in “CMS Proposed Rule Expands Multiple Procedure Payment Reductions to Professional Component…,” published by RBMA

CMS Proposed Rule Expands Multiple Procedure Payment Reductions to Professional Component of Advanced Imaging Services
By: Elizabeth Sullivan

On July 1, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released a proposed rule addressing modifications to physician payment policies and rates for 2012. Included in the rule is a proposal to expand the Multiple Procedure Payment Reduction policy (“MPPR”) to the professional component of certain imaging procedures. Currently, the MPPR only applies to the technical component of such imaging services.

For many imaging services, the proposed rule would reduce the professional component payment for second and subsequent imaging services by 50% just as technical component payments are currently reduced. CMS estimates that it could result in a savings of about $200 million.

When the MPPR was introduced for the technical component of imaging services in 2005, CMS noted that many of the clinical labor activities and supplies involved in a diagnostic imaging procedure were not repeated when a patient underwent multiple procedures in a single session. The clinical labor activities noted in the proposed rule included greeting the patient, positioning and escorting the patient, providing education and obtaining consent, retrieving prior exams, setting up the IV and preparing and cleaning the room. CMS declined to include professional component payments in the MPPR and stated in the final rule that it was not certain whether the MPPR would be appropriate for professional component payments.

The recently issued proposed rule clarifies that CMS is taking a different approach to professional component payments beginning in 2012. In the proposed rule, CMS states that it expects efficiencies to emerge from the performance of multiple services in the same session due to duplication of physician work, both in the pre- and post-service periods, as well as during the intraservice period. CMS noted that Medicare has a longstanding policy of reducing payment by 50% for second and subsequent surgical and nuclear medicine procedures furnished to the patient by the same physician on the same day.

The proposed rule also includes forward-looking statement about future expansion of the MPPR in the imaging field. While the current MPPR is specific to certain specified CPT codes, CMS is considering applying the MPPR to the technical component and/or the professional component of all imaging services and considering whether the MPPR should be expanded to include all diagnostic tests.

The comment period on the proposed rule is open through August 30, 2011. Interested parties should prepare and submit comments now. Comments relating to the future expansion of the MPPR will also be considered.

The proposed rule may be found at: http://www.ofr.gov/OFRUpload/OFRData/2011-16972_PI.pdf.

View the related Fact Sheet from CMS at: http://www.cms.gov/apps/media/press/factsheet.asp

Reprinted with permission from RBMA RadCast July 2011 issue.

http://www.rbma.org/Products_and_Resources/Legal_Resources/RBMA_Monthly_Legal_Update_Digest_July_2011.aspx