BCBSM Physical Therapy Reimbursement Policy to Align with CMS Guidelines, Protect Members from Paying for Duplicate Health Care Costs
Blue Daily
| 3 min read
At a Glance:
- An April 1st policy update for Blue Cross Blue Shield of Michigan commercial plans adjusts payments to account for duplicated costs that occur during physical therapy sessions when multiple services are performed.
- It protects our members by promoting efficient, coordinated care and reducing payment of duplicate costs.
- Our commitment to our provider network is evident in our payment rates, which are higher than other Michigan health plans, and we provide consistent increases in our physical therapy provider reimbursement rates.
Understanding MPPR: A step toward better, more efficient care
Blue Cross Blue Shield of Michigan is committed to making health care more affordable and accessible for our members. We believe that quality care should be accessible to every member while maintaining a sustainable and affordable health care system.
On April 1, Blue Cross will implement the Multiple Procedure Payment Reduction (MPPR) policy for physical therapy to commercial health insurance plans. This policy is not new. It was applied within Blue Cross Medicare plans several years ago, and it aligns with the Centers for Medicare and Medicaid Service’s (CMS) multiple procedure reduction policy (MPRP).
What is MPPR and why do we use it?
Many of the costs involved in a physical therapy session are shared among multiple procedures. Paying full price for each one would essentially be duplicating costs that have already been covered—similar to paying twice for the same ingredients in a recipe. Instead of paying full rates for each procedure, MPPR ensures that providers are compensated based on the either the primary or highest payable service, while additional services that share overlapping costs receive a reduced rate. These duplicated costs that the policy aims to reduce include:
- Facility and equipment use: When two or more procedures are done in one session, the same treatment room, equipment, and supplies are used.
- Efficiency of time and effort: The provider’s time during a single session is continuous, even when different techniques are applied. This policy acknowledges that certain operational costs do not reset with each technique, thereby optimizing the use and time of resources.
- Administrative overhead: Scheduling and other administrative processes occur just once per session, not per procedure.
- The average reimbursement rate Blue Cross pays to providers who treat members with a Blue Cross commercial PPO plan exceeds the average reimbursement paid by other Michigan insurers.
Protecting our members
We have a responsibility to be good stewards of our members’ health care dollars and to support care that leads to better member outcomes. This policy aligns with industry and current Blue Cross standards applied across many of our other procedural-based programs.
There will be no change to therapy delivery as a result of this policy change. Providers can continue their standard practices. Reimbursement reductions apply only to one part of the claim, Practice Expense (PE) component, which covers shared and likely one-time costs like staff time, room setup, patient education and equipment use.
A balanced approach for providers and members
We deeply value the expertise of our provider network and the exceptional care they deliver to our members. We are committed to creating opportunities for our network providers that prioritize better health outcomes for our members. We have attempted to engage the physical therapy community in our existing value-based programs that focus on quality outcomes and provide enhanced reimbursement, but they have declined.
Moving toward value-based care
Last year, Blue Cross experienced a $3 billion increase in medical and pharmacy claims paid on behalf of our members. We now pay $100 million every day for our members’ care and benefits. The responsibility for affordable care and coverage involves all of us – from payers to providers – and partnering is critical. It will take all of us, working together toward a common goal, to ensure health care can be affordable now and in the future.
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