April 24, 2024

ACR Asks Florida Blue Not to Implement Professional Component Multiple Procedure Payment Reduction

Florida Blue announced in its March provider newsletter that the insurer would implement a 5% multiple procedure payment reduction (MPPR) for the professional component of imaging services when multiple imaging procedures are performed on the same day by the same physician or physician group. The policy, effective May 1, is an extension of an existing 25% MPPR for the technical component of imaging services.

In response to the announcement, the American College of Radiology® (ACR®) sent a letter to the insurer asking Florida Blue to rescind the policy. The letter states, “As an organization representing physicians who specialize in diagnosing both severe injuries and life-threatening diseases, we are deeply troubled by this latest attempt to undervalue the role of radiologists within the health care delivery process.”

Application of an MPPR to the professional component of diagnostic imaging services is based on the incorrect assumption that there are significant efficiencies when radiologists interpret multiple imaging studies during a single patient visit. This logic fails to recognize that radiologists are morally and professionally obligated to expend an equal amount of time, effort and skill on interpreting images, irrespective of whether or not previous examinations have been performed on the same day. It is not uncommon for complex patients with trauma, cancer diagnosis and stroke to require multiple examinations on the same day.

Of further concern is the application of the MPPR to the professional component of studies performed by different physicians within the same physician group practice. By definition, it is a distinct and separate session when two physicians are involved in providing professional services to a patient on the same day, and absolutely no efficiencies occur when more than one radiologist is involved in furnishing the professional components of multiple advanced imaging services.

For questions about the Florida Blue MPPR policy expansion, contact Katie Keysor, Senior Director, Economic Policy.