Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

Dialysis Billing Update: UHC Medicare Advantage

If you have patients with UHC Medicare Advantage Plan? Then this blog post is for you.

Starting October 1st 2021 UHC Medicare Advantage Plan updated their billing information in order to avoid Denials.

Modifiers: UHC Medicare Advantage Plan requests that providers bill the dialysis treatment with the following modifiers: CG or KX for dialysis treatment

Revenue Codes: 821 and 881

CPT code: 90999

Coverage: Dialysis treatments that exceed 14 treatments in a calendar month will be reviewed per CMS Frequency of Hemodialysis (A55703) LCD

If you would like to read the whole CMS Frequency of Hemodialysis (A55703) LCD please click here.


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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.


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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC Medicare Advantage: change in post-acute care management ,04/01/21

UHC partnered up with naviHealth to manage certain post-acute care administrative processes for Medicare Advantage members in Arkansas, Kansas, Kentucky, Maryland, District of Columbia, Oklahoma, Oregon, South Carolina, Virginia, Washington and Wisconsin. This includes:

  • Prior authorization
  • Concurrent (continued stay) review and discharge planning for skilled nursing facilities (SNFs)
  • Acute inpatient rehab (AIR)
  • Long-term acute care (LTAC)

This change will take affect as of 04/01/21 and for all DOS thereafter.

The Plans that this change applies to are:

  • Medicare Advantage plans, previously managed by UnitedHealthcare
  • Dual Eligible Special Needs Plans (DSNP)
  • Chronic Special Needs Plans (CSNP)
  • The Medicare component of Fully Integrated Dual Eligible (FIDE) plan (as applicable to your state)   

Plans not included:

  • Any Medicare Advantage members included in a delegated risk agreement to provider medical groups (e.g., Optum Care Network)

Questions regarding UHC and naviHealth Partnership:

Please visit: UHC and naviHealth Partnership Launch – naviHealth