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Radiology billing and coding is undergoing a drastic change ever since the announcement of 2017 Multiple Procedure Payment Reduction program. Since, its first appearance in the Medicare regulations, the radiology group has been quarreling with CMS about MPPR on the professional component of certain diagnostic imaging administrations. But finally, the Congress has found a way to moderate the effect of this new rule.
What are the new MPPR norms?
With the advent of 2017, Medicare will pay 95% of the charge plan sum (a 5% reduction) for the professional component of each additional administration outfitted by a similar doctor, to a similar patient, in a similar session, around the same time. Right now the reduction is 25% of the total fee amount, so this change of law will give a critical increment in reimbursement for the affected procedures. Medicare makes full payment for the highest priced procedure and applies the reduction to the second and consequent administrations.
The MPPR will keep on applying to the specialized segment at the rate of 50% of the overall fee schedule and when administrations are charged all inclusive, Medicare applies the reduction to the implied professional and specialized components of the overall expense. There is likewise no change to the list of MRI, CT, and ultrasound administrations to which the MPPR applies.
Healthcare insurance providers have their own payment policies that may or may not align with the regulations of Medicare. Some of the insurers adopted the MPPR for professional component services at the same 25% reduction as in the Medicare rule. Some have announced that it will roll back its MPPR to mirror the Medicare change. Radiology practices and their medical billing and coding teams should check with each of their insurance payers to verify whether this policy will be changed or not.
There are conditions where particular administrations are rendered and the MPPR should not apply. HCPCS Modifier XE (Separate Encounter, an administration that is particular since it happened amid a different experience) would be utilized on claims for this reason.
Different modifiers accessible to describe distinctive services are:
If you have in-house billers who are still unsure of the new Radiology prerequisite, it only makes sense, to outsource the work to a professional medical billing and coding company, who is abreast of the latest reforms.
You as a practitioner also have to take note that HCPCS modifiers are designed for use by Medicare, and they may or may not be accepted by some of the healthcare payers. Modifier -59 could be used as an alternative for other insurers or for Medicare claims when none of the X-Modifiers provides the best description. But, never use both Modifier -59 and an X-Modifier on the same claim line.
This change brought in by Medicare is only one of many impacting Radiology practitioner that has come into effect now. And as the field is too vast to tackle and numerous codes to remember, it provides an upper hand for facilities, if they align with the services of an offshore radiology billing and coding company, so that the errors are minimized, income cycle is accelerated, RCM is streamlined, AR days are lowered, and most importantly your facilities bottom line is augmented.
