Skip to main content

The insurers are mirroring CARES Act provisions that suspended the sequestration cut in Medicare payments.

Two of the nation's largest commercial insurers — Aetna and UnitedHealthcare — are following CMS' lead and temporarily suspending this year's 2% sequestration cuts to provider payments in Medicare Advantage plans. For both companies, the suspension applies to payments made between May 1 and December 31.

The shift comes in the wake of changes brought about through CARES Act COVID-19 relief provisions that temporarily halted a 2% cut in Medicare provider payments. Those annual cuts, mandated through the 2011 Budget Control Act, often have been passed along to providers participating in private insurers' Medicare Advantage plans. Now at least two insurers are following in kind by suspending the reductions for a limited time.

This isn't the first time commercial payers have mirrored — and even expanded on — CMS coverage and payment changes related to the COVID-19 pandemic. Most major insurers now accept claims for therapy delivered via telehealth, and BlueCross BlueShield Tennessee recently became the first major payer to include telehealth by PTs as a permanent benefit.  

Carmen Elliott, APTA's vice president of payment and practice management, says that continued communications between professional organizations such as APTA and the insurers are helping the payers make informed decisions about coverage during the pandemic and beyond.

"APTA and other provider associations have continued to share information with insurers to work toward collaborative approaches such as therapy via telehealth, and how the pandemic has impacted individual providers," Elliott said. "We certainly appreciate the ways in which these payers are closely following federal guidelines."


You Might Also Like...

Roundup

And the Beat Goes On: APTA's Commercial Payer Advocacy

Apr 21, 2021

Lots of payers with multiple plans mean the conversation never stops. Here are a few advocacy efforts that APTA is pursuing.

Article

Defensive Contracting: Extrapolation, E-Payment, and Virtual Credit Cards

Mar 30, 2021

A quick explanation of two payer activities that you may encounter in a contract: what they are, what to look for, and what you can do.

News

Anthem's UM Arm Releases Guidelines on Clinical Appropriateness

Feb 5, 2021

Included: lists of what is and isn't considered medically necessary under Anthem's MA, Medicaid, and commercial offerings.