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  • APTA Private Insurance Page Adds Expanded MPPR Resources

    The increased use of the multiple procedure payment reduction (MPPR) by private and workers' compensation payers is already affecting physical therapists (PTs), and it's now among the elements of the changing insurance landscape addressed in an expanded APTA private insurance website.

    APTA online resources now include targeted MPPR information related to the move made by private insurers to adopt policies first developed by the federal Centers for Medicare and Medicaid Services (CMS). The shift toward MPPR poses a risk to PTs, who need to carefully review contracts with insurers to evaluate impact. The APTA website includes tips on contract review that can help PTs determine if the policy is appropriately applied under the contract and payment guidelines to help PTs verify the accuracy of any overpayment amount claimed by the insurer.

    Several insurers, including Blue Cross and Blue Shield (BCBS) of Kansas City, BCBS of Missouri, Wellmark, Aetna, and UnitedHealthcare have implemented MPPR over the past 2 years, and are paying claims using an MPPR methodology.

    A recent example of the trend toward MPPR use surfaced earlier this year, when Humana announced that it would be applying MPPR policies, an approach that it had initially adopted in 2011 but quickly reversed. Not long after the reversal, Humana announced that it would be reviewing the MPPR payment methodology and stated that it may make changes to payments. When those changes were implemented, Humana made providers aware of its shift to MPPR by sending notifications of overpayments on claims as far back as 2012 for contracted providers. Noncontracted providers were told that they were responsible for overpayments dating back to 2011.

    In light of Humana's reversal on MPPR, APTA sent a formal letter (.pdf) to Humana's CEO addressing several areas that it views as problematic for PTs. APTA expressed particular concern over the lack of prior warning of Humana’s intention to adopt the policy, the administrative burdens associated with overpayment recovery, the appropriateness of MPPR's application to medical procedure codes, the suitability of application to all contracts, and apparent inaccuracies in calculations that result in incorrect overpayment amounts.

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