Medicare Fee Schedule Overview

The Medicare Fee Schedule is the allowed payment for Medicare services. The schedule is based on the physical expense of providing the procedure, liability of providing the procedure and effort required to provide the procedure. Medicare allowed fees are calculated based on the Relative Value Unit (RVU) of each procedure and adjusted for the geographical location where the procedure was performed.

The Medicare Multiple Procedure Payment Reduction Program (MPPR) decreases payment for the practice expense RVU when multiple procedures are performed on the same date of service for all therapy providers operating under the same National Provider Identifier (NPI). Effective April 1, 2013, the MPPR that applies to the practice expense was increased to 50 percent for all outpatient therapy settings and an additional 2% sequestration cut of the total allowed payment after the allowable fee is calculated and the MPPR reduction is taken into account.

Insight automatically performs this calculation for you if your clinic's payer settings are set. Use the following procedure to set the Medicare expected reimbursement.

  1. Log in to Insight EMR or Insight Billing.
  2. From the Edit menu, select Payers. Alternatively click or press F11. The Edit Payers dialog displays.
  3. Click the Payer arrow to display a list of payers.
  4. Select a payer from the list.
  5. Click the Fee Schedule tab.
  6. Click the Calculate Expected Using arrow to display a list of reimbursement schedules.
  7. Select Medicare RVU/Locality/MPPR with Sequester Discount to calculate expected reimbursement using the 2% sequestration cut or select Medicare RVU/Locality/MPPR if you do not want to factor the 2% sequestration cut into the expected reimbursement calculation.

Note: From the Billing menu, select Medicare RVU Schedule to download a copy of the Medicare RVU schedule in Excel format.

Related Links

CMS Therapy Services

CMS Fee Schedule Search

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