Tag: #skillednursing

Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

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

Posted on by KR2Medical Billing

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.

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Posted in Updates

Billing for Multiple Home Health Visits -UHC update, September 2020

Posted on by KR2Medical Billing

According to UHC, in order to prevent payment issues for multiple skilled nursing visits on the same day, providers need to bill in the following manner:

a. Bill each visit on its own line

b. Bill each visit with its RVU and  HCPCS/CPT codes

c. The subsequent visits should be billed with a qualifying modifier (ex. XE)

Adding the appropriate modifier will ensure that the additional visit will be identified and processed for payment correctly, at expected rate.

For more information, please click here, for UHC Medicare Advantage Guidelines/Definitions. .