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    Aetna to Implement Multiple Procedure Reductions for Therapy Procedures

    According to Aetna's June OfficeLink Updates, the insurer will apply multiple procedure reductions to certain therapy procedures for dates of service beginning November 14. The procedure with the highest practice expense relative value unit will be allowed at 100%. Each additional therapy service performed by the same provider group on the same date of service will be allowed at 80%.

    APTA is investigating to determine if this policy applies to all regions of the country, and whether the 20% decrease on subsequent services will be applied to the practice expense only—as is the case with Medicare's multiple payment procedure reduction policy—or if it is applied to the entire value of the procedure.


    Comments

    Problem with this is, is that Aetna does pay at the same rate as Medicare does on their fee schedule so the reduction should not apply.
    Posted by dano napoli on 6/13/2011 6:38 PM
    In Oklahoma, Aetna is replacing their reimbursement system, and subbing it out to a Kansas compay called ATA. They will pay a block fee based on the severity and diagnosis code. It limits payment to a paltry amount and then offers a $29.00 fee after the block fee is depleted. If you don't sign up for it, Aetna drops your contract.
    Posted by Michael Strakals on 6/17/2011 11:21 AM
    Wouldn't it be nice if they tried to find ways to pay us more instead of less? I dropped Anthem and my profits have increased. Go figure.
    Posted by Jeff Harband, PT on 6/17/2011 2:16 PM
    Does not make a bit of difference here in colorado where Aetna will only give us a capitated contract - subsequently our practice is not in their network - we need to stand up for ourselves.
    Posted by Bill on 6/17/2011 2:37 PM
    The real problem is the ongoing ‘insurance problem’. That is to say, insurances have been cutting PTs reimbursement for years now, and now the insurance companies are cutting those unacceptably low rates. Aetna cut our reimbursement for OP Ortho in CA a few years back by about 40%, then they cut the allowable number of yearly visits from 60 to 25, now they are cutting the already low reimbursements again. In CA for OP PT, Aetna’s reimbursements has not even compared to Medicare for years now. Welcome to the future everyone…..high volume or bust!!! What great care it will be! If you think this is the exception and not the new rule with insurances, think again. It will all head this way, or to just a capped fee for visit…yeah!!
    Posted by Bill on 6/17/2011 2:43 PM
    The quality of care will go down, the PT salaries must go down!
    Posted by cristina on 6/17/2011 3:49 PM
    We have to forget popts.......If we don't get paid enough to keep our practices open nothing is significant. This untenable spiral of increasing salaries, further Medicare time consuming mandates, one on one regulations and decreasing reimbursement is the number one concern in the real world.The math just does not add up. William Breland PT
    Posted by William Breland on 6/17/2011 3:55 PM
    Am assumming above comment meant to say "Aetna does NOT pay at same rate..." Regardless-- I personally doubt that Aetna cares about that detail -- I suspect insurers will use an a-la-carte mix of arguments to justify their unique payment methodology -- e.g: "well Medicare is doing it", to justify MPPR but some other rationale to justify a lower fee schedule or hard limitation on number of charges/day. In my area, Aetna already limits their charges to 4 timed units/day; so if they implement MPPR on top if it ... that will probably be goodbye to Aetna for us.
    Posted by Shannon Murphy on 6/17/2011 5:02 PM
    Current Aetna's reimbursement rates: For 97110: $19.14; For 97140:$17.94; 97035: $8.06; For 97014: $.9.23; Aetna allows 4 procedures per session. In a typical given session if patient receives 1 ex ($19.14)+ 1 Myofascial ($17.94)+ 1 US ($8.06)+ 1 Estim ($9.23) So In a typical session if all the above are perfrmed the current reimbursent is $19.14+$17.94+$8.06++9.23 = $54.37. I have already been thinking of dropping myself from Aetna because I have to pay the Therapist more than the reimbursement. Currently I am continuing to provide services because I do it myself as a owner working long hours. If I have to hire therapist it would be impossible to provide quality care.
    Posted by R.B. Reddy on 6/17/2011 6:00 PM
    A comment was removed because it violated our site's Terms & Conditions, which include the following: "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;" APTA urges commenters to review the Terms & Conditions. http://www.apta.org/TermsConditions/
    Posted by News Now Staff on 6/17/2011 6:56 PM
    Aetna lowered their fees in late 2010 in anticipation of Medicare lowering theirs (remember the 21% threat) and now they plan to lwer it again by implementing this additional reduction. Thety say they follow Medicare guidelines yet Medicaere raised what it paid to providers in 2007-2011 while Aetna kept the same fees in 2007-2009 then lowered in late 2010.
    Posted by Charles Kibbey on 6/17/2011 7:24 PM
    Welcome to health care reform. As it was during the Clinton administration the insurance companies got stronger and the health care providers and patients suffered. The insurance companies get double digit increases yearly, patients get less benefits with higher co pays, providers( MDs and PTs )get less, hospitals in our area get 4 to 20 times higher reimbursement than what private physical therapy practices. Must be because their care is so fantastic or is it the great push to move everything towards a hospital base system and eliminate private healthcare providers altogether - same as has happened to the mom and pop hardware stores and pharmacies during the last 30+ years. What good will higher education be when reimbursement continues to sink. Might as well become a massage therapist or a personal trainer with less practice restrictions and better reimbursement.
    Posted by William on 6/17/2011 10:57 PM
    A comment was removed because it violated our site's Terms & Conditions, which include the following: "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;" APTA urges commenters to review the Terms & Conditions. http://www.apta.org/TermsConditions/
    Posted by News Now Staff on 6/18/2011 9:14 AM
    The CEO of Aetna made 72 million dollars in 2010.
    Posted by Sara Nelson on 6/18/2011 11:50 AM
    Would anyone pls let me know if this Aetna payment reduction apply to out-of-network providers as well? If you dot't have any contractual obligations with insurane, should they pay what you bill them for? Of course, they do consider their customary and reasonable restrictions, and you can only work with the plans that have out-of-network benefits, but for me (small private practice provider) it could be the only way to provide quality of care. I spend one full hour one-on-one with each pt, doing a lot of manual work and then implementing very specific exercise programs, mainly based on Sarhmann's muscle imbalances approach. Today Aetna pays for 4 modalities only in my area (NJ). I really want to continue doing a good job for my pts, but how much more payment reductions can a small practice survive?
    Posted by Bella Kqavalerchik on 6/18/2011 12:50 PM
    If PT practices did not sign these low rates this would not be an issue. I often wonder how effective the APTA would be in addressing these issues if the numbers were there for political posturing. What at first glance may look like a private practice issue regarding fair business practices, is really the foundation for a change in how aides and assistants are utilized. the question remains as to what our job responsibilities will be in actuality.
    Posted by MaryEllen Axner on 6/18/2011 3:00 PM
    A comment was removed because it violated our site's Terms & Conditions, which include the following: "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;" APTA urges commenters to review the Terms & Conditions. http://www.apta.org/TermsConditions/
    Posted by News Now Staff on 6/18/2011 9:03 PM
    The real issue: Health care insurance with a profit motive. The real solution: Single payer health care that allows providers to collectively organize. When is the APTA going to follow the RN's example and become a strong voice for intelligent, meaningful and prudent health care reform?
    Posted by Jonathan Holtz on 6/19/2011 8:40 AM
    Terribly frustrating! we are expected to provide quality care with minimal payment. I believe that this is all a ploy to centralize all medical care in hospital settings and centers. Typical example is the ACOs which is going into effect in Jan. 2012.Where do we stand? What do we do? It is still fuzzy and I don't feel that we are getting accurate information and any guidance as to how to proceed. All I read is that its important to have gd legal and business advice. I agree that this is all a ploy to gradually eliminate the small private practices and direct patients to centers.I am a bit disappointed because I dont see much happening in our favor. We have been talking about eliminating PT Caps and POPTS and both are still alive and kicking! Things appear to be getting worse for the private practice practitioner. We are getting squeezed out of our profession. So we have direct Access , how are we benefiting fron this? Whats the point of getting a DPT???Could someone out there please tell me??
    Posted by Renee on 6/19/2011 10:13 PM
    I wish the APTA would stop selling us down the river by agreeing with all of these ridiculous cuts, and almost demanding that those of us who are veteran PT's go and get your doctorate...why? how can I afford to go back to school when my pay is smaller and smaller? so much for rural settings for new graduates, as the push is to bring everyone in on mass transit, of course, government sponsored, to be seen by government run "health care"...Oximoron if I do say so myself. I am not encouraging any of my voluteers to pursue a PT degree, it is not worth it.
    Posted by Renee Hill, P.T. on 6/20/2011 11:47 AM
    If we didn't have PTs accepting their reimbursement rates then the rates would be higher
    Posted by Karen Bonsack on 6/20/2011 12:30 PM
    A comment was removed because it violated our site's Terms & Conditions, which include the following: "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;" APTA urges commenters to review the Terms & Conditions. http://www.apta.org/TermsConditions/
    Posted by News Now Staff on 6/22/2011 11:40 AM
    What is APTA going to DO ABOUT THIS and other insurance cuts. ARe these cuts happening for all PT settings...or are small private practices getting discriminated at lower reimbursements like we usually do...which will eventually be the END of private practice. VISION 20/20 will be dead without us getting paid. The only thing i forsee is private practice being private pay if this keeps up.
    Posted by Cindy Marti on 6/23/2011 9:18 AM
    The problem with our profession is that very very few of us have a vested interest in making it succeed. Ask yourself how many PTs you know will take home less pay due to insurance cuts. My guess is even amongst the people reading this page the percentage is very very low.
    Posted by Joel on 7/8/2011 2:43 PM
    There is direct link between growth of profession, education and money earned.All three factors are linked to each other.We can not leave one factors and work for other two.We can over come this problem and become attractive profession if we are united.For some benefits our friends sale this profession .We are our own enemies. we have to correct our self quickly. Then you see our influence.
    Posted by Deepak sardey on 7/11/2011 9:27 AM
    I am a chiropractor and they are doing the same things to us. We all need to band together and fight off the insurance industry. Stop fighting against each other. Fight the real evil.
    Posted by David Shaffer on 11/22/2011 9:30 AM
    I really want to drop AETNA ....they are telling us they need 180 days as per contract signed....but aren't they breaking the contract by lowering the fee? any ideas will help
    Posted by jose on 1/11/2012 12:59 PM
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