• Friday, October 14, 2011RSS Feed

    UnitedHealthcare® Announces Multiple Therapy Reduction Policy

    Modeled after the multiple procedure payment reduction policy implemented by the Centers for Medicare and Medicaid Services, UnitedHealthcare (UHC) will implement a new multiple therapy reduction policy on physical medicine and rehabilitation services effective March 1, 2012. The October 2011 OptumHealth physical health provider newsletter provides details on the multiple therapy reduction policy, which will apply to UHC claims only. UHC's intent is to use the code with the highest practice expense value as the primary procedure. OptumHealth is evaluating the policy and will notify its providers in a future newsletter if it will be implemented in OptumHealth systems. The policy does not apply to providers contracted at a flat rate per diem payment methodology. 

    OptumHealth's physical health provider newsletter is available online for contracted providers through its member-protected Web site. The bulletin will be available online in November through UHC's Web site and will be accessible to providers both in and out of network (OON). This will give OON providers advanced notice prior to implementation.

    APTA will submit a letter of comment to UHC.


    Comments

    I am sure just another rate cut, in an area already severely underpaid. Private clinics will unfortunately be a. thing of the past!
    Posted by Ron White on 10/14/2011 4:12 PM
    Will the $68 per p.t. visit be void or is this on top of the fixed rate?
    Posted by Debbie DiGiordano on 10/14/2011 4:23 PM
    A trend we will see in the insurance industry. Another way to reduce payment for services rendered
    Posted by Fred Wingate on 10/14/2011 6:05 PM
    Optum rate is already super low. We have to stop accepting these low rates from these companies. We deserve more for our service and expertise.
    Posted by Anne Holess on 10/14/2011 6:59 PM
    Just another reason to not contract with UHC.
    Posted by Scott J Schultz on 10/14/2011 7:16 PM
    I find it rather interesting that UHC is considering even lower reimbursement.(It currently is a break even contract now.) We have UHC insurance for our employees and they have raised their rates 12-20%/year for the last 6 years. Where is the providers rate increase?
    Posted by Jerry McCollow on 10/15/2011 1:44 AM
    Several comments have been removed because they violate the Terms & Conditions of APTA.org, which include: "Do not post anything which could encourage or facilitate discussions or any agreement that either expressly or impliedly leads to price fixing, a boycott of another's business, or other conduct intended to illegally restrict free trade;" For more, please review http://www.apta.org/TermsConditions/
    Posted by News Now Staff on 10/15/2011 4:20 PM
    Interesting to see all of these insurance companies adopting MPPR "because Medicare does it" yet they fail to reimburse even half of what Medicare pays to begin with. Must be nice to be able to pick and choose only those CMS policies that will save you money. Meanwhile MPPR is flawed from the start because it assumes some how that a PT's costs are less for providing a second unit of care of that a second unit has less value yet we are forced to bill in timed units, Reversing MPPR all together should be APTA's focus
    Posted by Eric E Douglass on 10/16/2011 11:03 AM
    It's also funny that discussions we have could be implied as price fixing, yet when other insurance companies follow what the Medicare program does and reduces their rates because the Medicare program did, it's not considered price fixing on their end.
    Posted by Rick Gawenda -> =IY`?L on 10/16/2011 4:46 PM
    Is this reduction mimicing CMS MPPR. The description indicates "code" vs. unit? Nancy MullinsPT
    Posted by nancy mullins on 10/17/2011 10:01 AM
    Unfortunately, UHC is not even the lowest at this time. Other commercial payers have already dropped their payments. If they can pay at a per diem rate, PTs should be able to charge a per diem rate. What's up with allowing only ONE PAYMENT PER DAY?
    Posted by Randyl Kirkland on 10/17/2011 1:45 PM
    I'm so incredibly glad I don't have to deal with or worry about this stuff. [url=http://www.drjarodcarter.com/]Jarod Carter PT,DPT,MTC[/url]
    Posted by Jarod Carter PT, DPT, MTC on 12/26/2011 2:09 PM
    Not only are they reducing they are recoding if the code has multiple units, we billed 97110 two units and 97035 one unit and UHC recoded on the EOB as 3 units of 97035 and one unit of 97110 and denied the 97110 as frequency of services??? How do we bill a second insurance with this info, nothing matches what we truly billed. I think they are going to get in trouble over this new "CORRECT" way of recoding and repricing.
    Posted by Debby Beck on 3/21/2012 9:41 AM
    I can't say enough good things about them.
    Posted by GARRY WARNER DC on 9/5/2012 12:21 PM
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