Insurers Announce New Reimbursement Policy for Multiple Therapies
SOURCE: The American Chiropractic Association
By: Bobby Gibson, Director of Operations
United Healthcare (UHC) and Aetna recently sent out notices to providers detailing their new Multiple Therapy Reduction policies. These policies reduce the reimbursement for the practice expense portion of the relative value units (RVUs) for certain therapies beyond the first therapy billed. The rationale is that there is duplication of the practice expense portion of the RVU.
UHC and Aetna are following the lead of the Centers for Medicare and Medicaid Services (CMS) after it initiated a similar policy on Jan. 1, 2011. CMS originally proposed a reduction of the second and any subsequent therapy practice expense portions by 50 percent. When that policy was proposed, ACA partnered with other provider organizations to contact Congress to oppose the policy. Due to the large amount of opposition, CMS decided to lessen the reduction to 20 percent rather than the proposed 50 percent.
UHC’s policy will affect claims with a date of service on or after March 1, 2012 and will affect claims paid by United. It will not affect claims on any plans in which Optum processes or pays the claims or plans in which providers are paid a flat per diem visit fee. Aetna’s policy took effect November 14, 2011, and to the best of our knowledge affects all Aetna plans. To illustrate how this policy will play out, we have created the following hypothetical example: (more…)