The American College of Radiology (ACR) is encouraging private payers to eliminate or reduce discounts associated with their professional component multiple procedure payment reduction (PC MPPR) policies for medical imaging in light of recent Congressional actions mandating a much lower discount.
The Consolidated Appropriations Act of 2016, which was signed into law on December 18, 2015, includes provisions that substantially roll back Medicare’s 25% professional PC MPPR for advanced diagnostic imaging services. Effective January 1, 2017, the Medicare PC MPPR will fall to 5%. The reduced discount will apply to reimbursement for image interpretation performed by one or more radiologists who read multiple images from the same patient, acquired on the same day during a single imaging session.
On November 15, 2015, UnitedHealthcare (UHC) implemented a 25% PC MPPR to align itself with Medicare policy. Prior to implementation, the ACR held conference calls with UHC officials to discuss the impending action. In October 2015, the College sent a sign-on letter to the insurer on behalf of more than 1,800 physicians in opposition to its planned implementation of the flawed policy.
UHC officials moved forward despite these efforts, though they encouraged the ACR to keep them informed about any changes to Medicare policy. After the Consolidated Appropriation Act was passed, they indicated to the ACR that they were awaiting instructions from the Centers for Medicare & Medicare Services on how they plan to implement the change. ACR leaders will convene another conference call with UHC leadership in the near future.
The ACR is also aware of several local-level insurers that have implemented PC MPPR policies. We will work similarly with state ACR chapters to urge these payers to align their policies with the new federal law. If you are aware of any private payers in your area that have implemented a 25% PC MPPR, please contact Katie Keysor at firstname.lastname@example.org.