Insurer Uses Medicare MPPR to Reduce Payments
In a recent Florida 4th District Court of Appeals case, the Court ruled on behalf of State Farm to reduce payments utilizing Medicare’s Multiple Procedure Payment Reduction method.
State Farm appealed the original case by asserting that a limit on price per procedure is not a limit on number of procedures utilized.
“As State Farm argues, the schedule of maximum charges is simply a base rate that may be adjusted downwards by applying Medicare coding policies and payment methodologies, such as the MPPR, to determine the appropriate amount of reimbursement,” the appellate panel said.
The appellate panel also ruled that State Farm had given adequate notice that it intended to use Medicare rules to determine appropriate reimbursement amounts. The insurer filed a policy form with the Florida Office of Insurance Regulation stating that it would use “Medicare coding policies and payment methodologies.”
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