Insurers Announce New Reimbursement Policy for Multiple Therapies

The Chiro.Org Blog

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:
Example Rate for a specific Therapy = $20

% Total RVU for Practice Expense Portion = 50%*

20% Reduction of the Practice Expense Portion = $2

New Reimbursement Amount = $18

* Please note that the 50% Practice Expense mentioned in this example is hypothetical. Some procedures have a practice expense that comprises greater than 50 percent of the total RVU, and some have less. Review this list of Physical Medicine Procedures on Page 18 to compare total RVUs and the Practice Expense component for any service you may provide.

To view Aetna’s new policy, please click here
(refer to pages 17 and 18).

To learn more about RVUs, refer to this document from:
The American College of Radiation Oncology