Physical therapists (PTs) who contract with Humana have been finding out about the managed care company's shift to the multiple procedure payment reduction (MPPR) policy the hard way—by being notified that they have to reimburse the company for payments they've already received. Humana has informed APTA that it plans on moving away from its practice of retroactive "overpayment recovery" and is working to fix errors in how the policy has been applied and calculated, but the insurer warns that it may be some time before all changes are in place.
Earlier this year, Humana began applying the MPPR policy on Medicare Advantage and commercial insurance plan payments for physical therapy, a change that resulted in reductions in payments to PTs. APTA wrote a letter (.pdf) to the company in early October outlining concerns over both the flawed MPPR policy and Humana's implementation of it. Among the concerns APTA voiced were issues around lack of provider notification, the burden placed on PTs through overpayment recovery, the inappropriate ways Humana applies MPPR on a per-visit basis, and inaccuracies in Humana's overpayment recovery calculations.
In its response letter (.pdf) to APTA, Humana acknowledged that it intended for the policy to be applied only to fee-for-service arrangements and identified 5 per-visit claims that it had incorrectly processed. The company also admitted that errors were made in MPPR calculations for some claims, and reported that it is reviewing all calculations and completing any corrections by the end of the year.
Humana described its overpayment recovery system as "not ideal" and wrote that "it takes time to make the necessary changes to apply this payment policy on initial claims processing." However, the company provided no timeline for when it would make the shift away from retroactive reductions.
APTA remains concerned about the administrative burden on providers subjected to MPPR through overpayment recovery instead of on initial payment and will continue to discuss this issue with Humana representatives in the coming weeks. Your direct experiences and documentation can support this discussion: send an e-mail to firstname.lastname@example.org with your name, member ID, and contact information for staff follow-up.
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