In response to efforts by the American College of Radiology (ACR), UnitedHealthcare (UHc) has announced it will reduce its multiple procedure payment reduction (MPPR) discount for the professional component (PC) of advanced medical imaging from 25 percent to five percent, effective Jan. 1, 2017. The revised policy is described in the private insurer’s November Network Bulletin.
As reported in Advocacy in Action, UHc notified the College in early September about its intent to modify its MPPR PC discount rate to align with the congressionally mandated change to Medicare policy. The notification followed passage of the Consolidated Appropriations Act of 2016 in December 2015. A provision of the new law required Medicare to cut its PC MPPR for advanced imaging from 25 percent to five percent.
The ACR urged UHc to change the PC MPPR policy for its health insurance network at that time, but executives decided to wait for specific instructions from the Centers for Medicare & Medicare Services (CMS) before taking action. In August, CMS released instructions to its contractors to implement the policy change as mandated on Jan. 1. UnitedHealthcare’s revised policy mirrors that action.
The ACR continues to work with its Managed Care Network to ensure that private payers realign their PC MPPR policy with the new Medicare policy.
If you are aware of private payers who continue to apply a 25 percent PC MPPR, please contact Katie Keysor at firstname.lastname@example.org.