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  • Humana Temporarily Ceases Overpayment Recovery

    The Humana health insurance corporation has put its overpayment recovery efforts on hold while it considers how it will implement its plan to apply the Multiple Procedure Payment Reduction (MPPR) policy. Prior to this announcement, the company was requiring physical therapists (PTs) to pay back portions of reimbursement that Humana claimed exceeded MPPR standards.

    Humana began applying the Multiple Procedure Payment Reduction (MPPR) policy on Medicare Advantage and commercial insurance plan payments for physical therapy in 2013, a change that resulted in payment reductions to PTs and overpayment recoveries. APTA staff has been in communication with Humana representatives to express concern over the way Humana implemented the policy. In a recent conference call with APTA staff, Humana representatives reported that the company is "no longer in recovery mode."

    Additionally, Humana representatives indicated that due to calculation errors, some recovery amounts were too high, and the company would refund PTs who experienced excessive recoveries. Additional discussions are expected regarding Humana’s future plans for policy implementation.

    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. Your direct experiences and documentation can support this discussion: send an e-mail to advocacy@apta.org with your name, member ID, and contact information for staff follow-up.


    • Thank you so much for the help with this!! It's been an administrative/accounting nightmare and Humana made lots of errors on payments, request for refunds & take backs. We received only one response to our multiple appeals letters for them to review this. I'm glad that I was able to send you information concerning that. Now...if we could only do away with those authorizations for Humana Medicare Advantage--lots of work for everyone, do know that they changed their policy for the PFFS plans starting next week. Good work APTA!! Thanks again! Cathy

      Posted by Catherine Gates on 1/10/2014 8:02 PM

    • I am so relieved that APTA is a part of this resolution with Humana. As I'm sure everyone is noticing, the refund requests are not only a burden to our busy schedule but also confusing. The calculations themselves to figure out if the requests are valid are worse than calculus! As far as trying to avoid them recouping the money from future payments: good luck! I too sent letters of appeal to Humana for claims they stated was not paid correctly that paid over a year ago. My argument was even supported with documentation from my states statutes that insurance will not recoup money paid over a year ago. This did not stop them. Thank you APTA! Keep it up! Fabiola

      Posted by Fabiola Felix on 1/13/2014 10:37 AM

    • We are so grateful for APTA in trying to assist LPTS in dealing with Humana. Like everyone else we have tried to talk with Humana and rarely does anyone call us bacd. We were to receive a payment for $433.00 only yesterday, but was taken back from ?overpayment in 2010. We have told Humana Provider Integrity about this and that we do not think they can recover 4 years prior in Ky. We have faxed our agreement in 2012 for flat rate per visit to only have Humana to take back what they consider overpayment as they went line by line. They continue to tell us auditors say they are correct. Posted by Carolyn Myers for Tonya Chadwell EXCEL PHYSICAL THERAPY.

      Posted by Tonya Chadwell -> >KPaCG on 5/13/2014 8:37 AM

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