Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC: Payment for COVID-19 testing coverage, outpatient SNF

Previously, UHC would not reimburse for COVID-19 testing when done outside of a skilled inpatient stay at a SNF.

However, during the PHE, starting Jan 27,2020 and then renewed on April 21,2021, subject to further extension, UHC is going to pay for the COVID-19 testing that is done outside of the skilled inpatient stay at a SNF.


This change applies to the following Medicare Advantage Plans:

  • Medicare Advantage Plans
  • Dual Eligible Special Needs Plans (DSNP)
  • Chronic Special Needs Plans (CSNP)
  • UnitedHealthcare Assisted Living Plans (IE-SNP)
  • FIDE/MMP Plans

Plans that this change DOES NOT APPLY TO:

  • UnitedHealthcare Nursing Home Plans (ISNP)
  • UnitedHealthcare commercial plans
  • UnitedHealthcare Community Plans (Medicaid Only Plans)

UHC will re-process the claims, there is no further action needed.

UHC will reprocess claims previously paid at $0 to be reimbursed at 100% of the Medicare fee schedule. No action is required from affected SNFs for these adjustments.


The following codes are going be reimbursed at 100% of Medicare Fee Schedule:

Reminder!

COVID-19 testing performed during an approved skilled stay are subject to Centers for Medicare and Medicaid Services (CMS) consolidated billing rules and are not separately reimbursable, except for the UnitedHealthcare Nursing Home Plan (ISNP). New applicable CMS covered COVID-19 testing codes may be added periodically. We may add or remove codes from the following list, in accordance with CMS coverage guidelines.


Find this information helpful? Then subscribe to my blog, via my home page! Check out my on demand webinars, coming soon! As well as members only subscription: where we will dive into the updated/current reimbursement policies for various insurance carriers.


In a meantime, check out my latest posts below:

Posted in Training, Updates

EmblemHealth (NY)- updated medical billing and coding for COVID-19 specimen collection

Effective 07/01/2020-

Medicare and Commercial:

Effective for DOS 03/01/2020 and thereafter

 These codes should only be used when the provider or facility is NOT running the test.

+Providers should bill 99211-CS for collecting specimen in the office setting.

+Independent clinical diagnostic laboratories should bill G2023  or G2024 (for patients that are homebound, in skilled nursing facility)

+Outpatient Hospitals should use C9803 to code for symptoms assessment and specimen collection.

Medicaid:

Effective for DOS 05/01/2020 and thereafter (consistent with NY Medicaid billing guidance)

+Practicioners and Clinics should bill G2023  or G2024  -this code should be bill ONLY when NO OTHER service was given to the patient on that particular DOS AND the provider is NOT billing for Laboratory COVID-19.

+ Independent Laboratories (POS 81) are NOT reimbursed separately for specimen collection

Code Definitions:

G2023  – Specimen collecton for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) by a laboratory on behalf of a home health agency, any specimen source

G2024 – Specimen collecton for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) from an individual in a skilled nursing facility by a laboratory, any specimen source

C9803  – Hospital outpatent clinic visit specimen collecton for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source

99211-CS – Use for specimen collecton in the physician ofce for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source

Posted in Insurance, Payers and CPT reinbursement, Training

UnitedHealthCare COVID-19 Physical , Occupational and Speech Therapies Telehealth Coverage- update 04/20/2020

As of 04/20/2020 UHC announce that it will cover PT, OT and ST services for its members. enrolled in Medicare Advantage, Medicaid, Individual, and Fully Insured Group Market Plans.

This applies to services performed between 03/18/2020 and 06/18/2020

Q.Covered Services?

A. The services have to rendered using interactive live audio-visual technology. During the live video conferencing both parties must be present- patient and the provider.

Q. What is NOT covered?

A. E-mailing “stored” exercise videos to the patient and using a phone to review or discuss them with the patient.  

The providers have to be certified in the given state, where they are providing the service.

Cost sharing will be waived for the services performed by IN-Network providers only. There is an Opt-in option for self funded employers.

Billing & Coding:  Applies to all lines of business.

The complete list of acceptable/reimbursable CPT codes could be found by clicking HERE.

Services that are billed on HCFA 1500 form with modifier 95 with a Place of Services where the services would be furnished in person.

Services that are billed on UB04 should be billed with revenue code 780.

Utilization Management:

There is no change to the utilization management requirements for PT, OT, ST.

Please remember that the claims will be processed based on UHC member’s benefits plan.