Physical therapists who returned payments to Humana following the implementation of its multiple procedure payment reduction (MPPR) policy should soon receive refunds from the insurer.
Without advanced notice to providers, Humana implemented MPPR for therapy services, effective January 1, based on the methodology used by Medicare for the physician fee schedule. However, Humana did not have an automatic process in place to adjudicate claims correctly based on this methodology. In addition, Humana failed to implement its MPPR policy on January 1; rather it implemented the policy retroactively, sending payment recovery letters to physical therapists requesting refunds for overpayment of claims this summer. APTA contacted Humana to obtain additional clarification and was informed that the insurer will refund monies recouped from physical therapists, as the recovery attempts were invalid. Physical therapists should expect to see refunds from Humana within the next 30 days.
It is important to note that Humana will continue to review the MPPR payment methodology and may consider it for future changes to payment.