February 2012

The First MPPR Rule of Fight Club
By Jim Knaub
Radiology Today
Vol. 13 No. 2 P. 3

If you’ve seen Fight Club, the disturbing film based Chuck Palahniuk’s terrific book, you probably understand how the modern world can utterly muddle the distinction between what is real and what’s in your head. Government regulation can do that, too.

In a recent visit to Centers for Medicare & Medicaid Services (CMS) headquarters in Baltimore, I picked up some breakfast at the Sodexho Café and Food Court in the lower level of the central building, spending $9.75 on a bagel, yogurt, coffee, and a banana. Then I headed upstairs to have the Multiple Procedure Payment Reduction Rule (MPPR) explained to me by CMS officials. The rule, which initially covered only the technical component of some imaging services but was expanded to include the professional component beginning last month, states that the organization pays imaging providers the full professional payment for a procedure with the highest payment under the Medicare Physician Fee Schedule and then pays 75% for the second and subsequent services provided for a given patient on the same day.

I told a CMS spokesperson that the reasoning seems kind of arbitrary but was assured there was work-related economy that justified reducing reimbursement for multiple services provided to the same patients in the same place on the same day.

On the way out, I was still hungry and stopped by the food court to grab a sandwich for the ride home; I handed the cashier $6 for the $8 roast beef on sourdough.

“You still owe me $2, sir,” the cashier said politely.

“But this is the second time you’ve served me during today’s visit,” I said. “You should be paid 25% less this time.”

“And just where did you get that numbskull idea?” the surprised cashier asked.
“From the bosses upstairs,” I replied, grabbing my sandwich and heading toward the door.

For a moment I felt like Tyler Durden.

As best as I can tell, this is all true except for the parts I made up—which is pretty much all of it except for the description of the MPPR rule and there actually is a Sodexho Café and Food Court at CMS headquarters.

Enjoy the issue.