Private practices and facilities (skilled nursing facilities, rehab agencies and hospitals) are reporting difficulty getting paid for outpatient therapy claims with Humana’s commercial and Medicare Advantage insurance plans. The American Physical Therapy Association (APTA) has received many complaints from their members regarding the retroactive application of the multiple procedure payment reduction (MPPR), further reductions to in-network providers’ rates through the MPPR, confusion around Humana’s approach to anatomical modifiers, and inconsistent application of the 59 modifier, with denials occurring even when the modifier was visible on the claim.
APTA staff have been in discussion with a representative from Humana to facilitate a resolution to the problems. As part of those efforts, APTA is urging members to contact the association by email at firstname.lastname@example.org, or by phone at 800/999-2782, extension 8511, to share any new or ongoing issues they’ve had with Humana.
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