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  • Aetna Clarifies MPPR Methodology

    With numerous multiple procedural payment reduction (MPPR) policies in effect, it is important for physical therapists to understand the methodology each payer uses in determining payment. Aetna's methodology for the application of its MPPR policy varies slightly from the policy adopted by the Centers for Medicare and Medicaid Services (CMS). CMS has only 1 payment rate and payment structure in a given geographic area, while Aetna may have several different types of payment structures in the same area. Therefore, Aetna is unable to efficiently apply the exact CMS calculations to arrive at a final payment amount.

    Aetna bases its reduction for the second and subsequent therapy services on the contribution of the practice expense relative value unit (RVU) to the total RVUs for a given procedure. Aetna, unlike CMS, does not use geographic practice cost indexes (GPCIs) in calculating its reduction. An example of Aetna's methodology can be found here.


    • How can you say "multiple carriers" adopted this policy; other than Medicare? In Alaska it is difficult enough to find a regular provider. Your policy just restricts access for care ina limited 'environment.

      Posted by sundi Hondl on 4/14/2012 2:48 AM

    • When was the last time Aetna raised their fee schedule? They jump on board for Medicare's reductions but have never heard of INFLATION. Insurance companies will continue to lower fees and cheat providers until they fight back. Physical Therapy is a valuable service and should be paid at professional rates. When was the last time policy premiums went down. NEVER and they never will go down.

      Posted by Greg Crawford on 4/16/2012 8:10 PM

    • I agree with the previous comments. If payments don't keep up with inflation but instead continues to decrease will not only restrict access for care but potentially kill the profession. I personally know of several therapist going back to school in other professions. We study hard and work hard to keep current in the care for our patients but we also have to make a living. It is a high quality service in health care. We must fight back. I don't know of any carrier who has increased reimbursement with inflation in mind nor cost to provide care. On the other hand they figure it well when deciding to increase premiums.

      Posted by Charles Benford on 4/18/2012 12:14 PM

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