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  • Humana Completing MPPR Refunds, Delays Policy Implementation

    The Humana health insurance corporation has nearly completed processing refunds owed to practitioners who were incorrectly billed during an "overpayment recovery" process last year. The overpayments were part of Humana's attempt to implement the multiple procedure payment reduction (MPPR) policy retroactively, and the problems have contributed to a Humana decision to hold off on full MPPR implementation until the system can run more smoothly.

    Last summer, APTA raised questions about the accuracy of the overpayment calculations and concerns about the administrative burden of the overpayment recovery process on physical therapist (PT) practices, among other issues. As a result of those efforts, Humana temporarily ceased application of the MPPR policy in December 2013 to focus on correcting their payment logic and refunding inappropriate overpayment recoveries.

    Humana will delay MPPR implementation until the policy can be applied accurately and timely during initial claims processing. Humana representatives acknowledged that application of the MPPR policy is complex, and the overpayment recovery application of the policy caused unnecessary burden for PTs. The company is testing application of the MPPR policy and anticipates making an announcement about startup of the MPPR policy on initial claims in the near future.

    Humana will notify APTA in advance of the implementation date, and APTA will update members in a future News Now story.


    • Last year we were told the new MPPR rate would only amount to a 6-9% reduction in payment. For 2013 the reality is is 35% for a one hour treatment session. Who dropped the ball on this one? If things stay at this level we will see closure of many Private Practice clinics. This is unsustainable. R.P. Mann, PT, OCS #39825

      Posted by Robert Mann -> ?OX\A on 3/11/2014 11:55 AM

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