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 firstname.lastname@example.org with your name, member ID, and contact information for staff follow-up.
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