[Ohioaap-practicemanagers] Good news!! Change in UHC payment policies

[Price, Jonathan]

This news came through today from the AAP. Drs. Lander and Harbaugh have been tireless warriors with UHC and finally persuaded the payer on some key issues. They still want to work on the reduction in E/M payment that will occur when a procedure is performed on the same day. Please note the effective dates for the changes. UHC as far as I know is still a problem area for well and ill services on the same day

   Jon Price, MD FAAP,
   Co-chair, Ohio Chapter, AAP, Pediatric Council

From: Jon Price <njnprice at gmail.com>
Sent: Monday, June 25, 2018 3:14 PM
To: Price, Jonathan <Jonathan.Price at nationwidechildrens.org>
Subject: Change in UHC payment policies

[WARNING: External Email - Use Caution]




Sent from my Verizon 4G LTE Droid
▼ Hide quoted text
---------- Forwarded message ----------
From: "Terranova, Lou" <LTerranova at AAP.ORG<mailto:LTerranova at AAP.ORG>>
Date: Jun 25, 2018 2:17 PM
Subject: UHC Reimbursement Policy Changes
To: PEDCOUNCIL at LISTSERV.AAP.ORG<mailto:PEDCOUNCIL at LISTSERV.AAP.ORG>
Cc:

On behalf of the Payer Advocacy Advisory Committee (Formerly known as PPAAC), we have some updates to share from UnitedHealthcare related to payment policy updates. Richard Lander, MD, FAAP and Chip Harbaugh, MD, FAAP of PAAC have worked diligently with UHC over the years to forge a more transparent and effective working relationship and we are seeing some of the benefits of the ongoing advocacy. Below are summaries of the changes to the UHC Reimbursement Policies that UHC will be implementing. While most of the upcoming UHC payment policy changes are very good for pediatricians, we will be working further with UHC and the other specialty societies to follow up regarding the Global Days policy change (see below).:

Vision Screening: Codes 99173, 99174 and 99177 will be paid for when reporting with a preventive medicine service code (eg, 99393) Effective 7-1-18
After Hours/Weekend Care: Code 99051 will be paid for when billed with acute care services (eg, 99213) and provided by primary care providers (PCPs) Effective 8-18-18
New Patient Visits: Consistent with CMS, E/M services not meeting the CMS new patient definition will be denied. The CMS definition is as follows: An individual who did not receive any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous 3 years. Effective 10-1-18
Consultation Services: PCPs will continue to be paid for consultation services 99241-99245 and 99251-99255. Aligning with CMS, however, UHC will continue to deny consultation services provided by specialists. Effective 10-1-18
Global Days: E/M services reported on the same day as a procedure code with a 0, 10, 90-day global period as outlined by CMS and when modifier 25 or 57 is required, will see a 25% reduction in payment. For example, if you report a 99213 25 along with a laceration repair code 12001 (000 day global) you will see a 25% reduction in your E/M payment. The AAP will work with other societies on this one. Effective 10-1-18
If you have any questions on the payment policy changes, please direct them to the coding hotline

Thank you!

Louis A. Terranova

Senior Health Policy Analyst

Divison of Health Care Finance

American Academy of Pediatrics

345 Park Blvd., Itasca, IL 60143

Email: lterranova at aap.org<mailto:lterranova at aap.org>

Phone: 1-630-626-6633

Fax: 847-434-8000

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.deltaforce.net/pipermail/ohioaap-practicemanagers/attachments/20180625/5dcdb450/attachment.html>