• Friday, October 14, 2011RSS Feed

    Humana Reverses MPPR Payment Methodology

    Note: There is more recent information since this article was published on October 14, 2011. See: Nonfederal Payers That Implement MPPR webpage on the newly created web resource "Adoption of Multiple Procedure Payment Reduction (MPPR) by Nonfederal Payers."

    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. 


    Comments

    I am curious when you received this clarification from Humana. My wife (PT/MBA/Non-member/Company president) spent a great deal of time in teleconference conversation with Tom, Corrine, Marcia, and Stacy (various positions at Humana) and our local PHO. Her efforts and conversation led to Humana asking her for the correct formula to determine the MPPR as their calculations were incorrect and they were requesting a higher amount than appropriate.
    Posted by Jerry Gillon on 10/14/2011 7:22 PM
    Humana Gold has started this practice again as of July 2013 going back to 2012. The requests vary for the same patient, same treatment codes, different days same week. One day they want 32% back another they want 13.6% back. Same patient same treatment codes. Makes no sense at all.
    Posted by Charles Hollier -> =HP_?J on 7/17/2013 6:36 AM
    My practice has had the same variances in refund request percentages as Charles in the previous comment. Does anyone know what is going on with Humana?
    Posted by Derek Tuohy -> >HU^BO on 8/14/2013 12:00 PM
    My practice is having the same issues as well. I don't suppose we will get an answer here though, as Humana themselves do not seem to know what they are doing.
    Posted by Mark Oertwig on 9/11/2013 12:10 PM
    As of September, they are now sending out refund requests citing the policy is retro-active to 2011. No clarification or source from their policy manual or website as of yet.
    Posted by Frances Thomas on 9/17/2013 2:19 PM
    It is an accounting nightmare. At least Medicare does in on the front end. I think the reason Humana does in on the back end is so their customers don't see that they have to pay $40 a visit while Humana now is paying me about $25 to $30 a visit depending on who is calculating the MPPR reduction. There seems to be no rhyme or reason to their requests. We may soon have to decline Humana patients as everyone else has done. We are one of the last in the area to still take Humana....soon there may be no one.
    Posted by William Russell -> >JS`>N on 10/7/2013 2:49 PM
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