How Changes to Medicare Have Affected Therapy in Skilled Nursing Facilities

Part Four: MPPR

MPPR stands for Multiple Procedure Payment Reduction.  This policy became effective on January 1st 2011.  CMS believed that providers of services under Part B were being paid more than they should due to the methodology of valuing the CPT codes.  This new policy is supposed to reduce payment for outpatient physical therapy services by 7-9% in 2011.  The MPPR policy provides for the first unit of the Always Therapy code with the highest  Practice Expense (PE) to be paid at 100% of the Fee Screen Rate.  All subsequent units/codes across all disciplines require a 20% reduction in the PE component of the Fee Screen Rate.  This policy is provider specific, not discipline or session specific. This means that for institutional providers that provide more than one discipline per day will have all but the highest PE reduced.

With this change, how do we “counteract” the adjustments?  We’ve had to go on “business as usual,” or do we?  We are always looking to improve the quality of care we provide to our residents and establish programs that insure the follow through with nursing staff when therapy is concluded.  This final change was just a friendly reminder that we need to continue to pursue this goal.  If we are effectively meeting the needs of all of our patients while they are on caseload, and developing effective programs to insure that nursing staff is carrying out our recommendations, and we are monitoring the progression of residents in these programs, then we will only be minimally affected by this last change to Medicare.

What’s next?  MDS 4.0?  RUGs V?  Med B Cap Appealed? More changes to the MPPR?  Change in how to bill Group Therapy? Whatever the change, we as therapists and therapy companies, will find a way to adjust, adapt, educate, and survive, in order to provide the best possible care to our patients, despite the payer source or description of our services.


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Odyssey Rehabilitation – Partners with long-term care facilities to provide affordable, compassionate PHYSICAL, OCCUPATIONAL and SPEECH THERAPY services in addition to complete, comprehensive management for your rehab department.
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3 Responses to How Changes to Medicare Have Affected Therapy in Skilled Nursing Facilities

  1. Medicaid is the federal program, administered individually by each state, that provides medical benefits for seniors and others with low-income and few assets. In every state,
    Medicaid pays the full cost of care in a nursing facility for someone eligible for the program.thanks for sharing with us !
    Skilled Nursing Facilities Decatur

  2. Senior Health Service provides are Responsible for the promotion and protection of the public’s health through education, disease and injury prevention. Thanks for sharing. Keep on doing the good work.
    Home Health Care Oklahoma City

  3. Ester Jones says:

    I’m curious, if any Skilled Nursing Facilities are “seriously considering” increasing their Private Pay beds, and decreasing the number of Medicaid Beds, in order to recoup dollars lost to the October 1st, 2010 changes?

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