UnitedHealthcare Reverses Plan to Stop Paying For Consultation Codes

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Update Sept. 19, 2017: Thanks to TMA advocacy, UnitedHealthcare (UHC) will continue to pay for consultation codes, the company announced Monday.

UHC had planned to stop paying for the codes starting Oct. 1. In response, TMA worked on a letter with the Medical Society of New Jersey urging UHC to reconsider the policy. The letter was co-signed by multiple state and specialty societies.

UHC said it will announce the delay in the October edition of its monthly newsletter.

Original story: So when UnitedHealthcare (UHC) announced in June that it will no longer pay for consultation codes, TMA joined more than 35 other medical and specialty societies to push back. The change will be effective Oct. 1, UHC says.

In a letter to Niel Patel, MD, medical director of reimbursement policy for UHC, the societies said the policy "will only create another barrier" to physicians' ability to care for patients, in light of "widespread changes afoot for the United States health care system."

The letter requests that UHC reconsider or delay the policy to give physicians time to learn to code properly under the new policy.

The societies' concerns centered around several major themes, including: 

  • Coordination of care: "It is important that UHC continue to recognize the additional work that goes into providing a consultation and coordinating care amongst other treating physicians."
  • Education, particularly for physicians who do not bill Medicare and are unaccustomed to the "crosswalk" between codes: "We hope that if UHC moves forward with this policy change that it will provide its network providers with the education necessary to properly code claims in order to avoid payment disruptions."
  • Payment, specifically UHC's claim that changes to evaluation and management (E&M) codes will make for a "budget neutral experience": "If UHC does not pay for E&M codes at an amount comparable to consultation codes, it will result in a financial burden to practices that provide consultations."
  • Coding abuse data, which UHC said was part of the reason for the change: "If abuse was occurring, we believe that UHC should address it with the physician(s) involved and not implement a broad policy that penalizes physicians who bill and document these codes correctly."
  • Confusing payer policies: "UHC is the only commercial payer that we know of that will no longer pay for consultation codes; it will be very difficult for practices to implement coding practices that are different for only one commercial payer; not to mention the time and attention necessary to review and implement coding crosswalks between the consultation and E&M codes to avoid payment delays and denials."
  • Future audits: "We ask that UHC provide guidance and assurance that specialists will not suddenly see an increase in audits due to a change in their billing practices." 

So we're working for you. As always, stay tuned to Action for updates.

Action, Aug. 1, 2017

Last Updated On

September 19, 2017

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