How to recover a Multiple Procedure Payment Reduction (MPPR) underpayment
MPPR reduces the payment on the second and subsequent procedures done on the same day, often by 50%. It's a legitimate policy, but it's frequently applied when it shouldn't be, at the wrong percentage, or to the wrong line.
How it shows up: A reduced allowed on the second and later procedures billed the same day (often CARC 59)Why it happens
- MPPR was applied to a code that's actually exempt from it
- The reduction hit the higher-valued line instead of the lower one
- The wrong reduction percentage was used
- It was applied across unrelated sessions or dates that shouldn't stack
What recovers it
- Confirm the codes are genuinely subject to MPPR, many are exempt
- Check that the reduction landed on the correct, lower-valued line
- Verify the percentage matches the payer's own MPPR policy
- Cite the policy and request repricing where it was misapplied
Worth recovering? MPPR is correct often enough that practices assume it's always right, but misapplication is common and adds up fast in surgical and imaging-heavy practices, where multiple same-day procedures are the norm.
Common questions
How do I recover a Multiple Procedure Payment Reduction (MPPR) underpayment?
MPPR reduces the payment on the second and subsequent procedures done on the same day, often by 50%. It's a legitimate policy, but it's frequently applied when it shouldn't be, at the wrong percentage, or to the wrong line. To recover it: confirm the codes are genuinely subject to MPPR, many are exempt; check that the reduction landed on the correct, lower-valued line; verify the percentage matches the payer's own MPPR policy; cite the policy and request repricing where it was misapplied. Because the claim already paid, the hard part is catching it, reconciling the allowed amount against what you were actually owed.
Is a Multiple Procedure Payment Reduction (MPPR) underpayment worth recovering?
MPPR is correct often enough that practices assume it's always right, but misapplication is common and adds up fast in surgical and imaging-heavy practices, where multiple same-day procedures are the norm. A no-risk service makes it easy to find out, you only pay on what's actually recovered, so there's no cost to surfacing the ones that are real.
How does Volari find Multiple Procedure Payment Reduction (MPPR) underpayments?
Volari reconciles every remittance line's paid and allowed amounts against what your contract and the payer's own rules say you should have been paid, surfaces the multiple procedure payment reduction (mppr) shortfalls no one flagged, and works the recovery. You pay 25% only on what's recovered, and nothing if nothing comes back.
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