UnitedHealthcare Nonphysician Billing Policy Cuts Payments, TMA Says
By David Doolittle

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A recent UnitedHealthcare (UHC) policy will not only cut payments by 15% to physicians who employ nonphysician providers (NPPs), but also cause needless confusion in the billing process.

That’s according to a letter the Texas Medical Association wrote to the insurer expressing concern over the policy, which took effect March 1.

UHC in December announced a policy that requires advanced practice nurses and physician assistants to bill for their services using their own National Provider Identifier (NPI) when they have not met “incident-to” billing requirements.

Payments billed using an NPP’s NPI number are typically 85% of the physician’s rate.

Despite medicine’s concerns, UHC further revised its policy in March to require that services provided by NPPs will be eligible for incident-to consideration – and thus the full 100% payment – only if the NPPs do not have their own NPI number.

That policy is scheduled to take effect May 1.

“It is TMA’s policy on physician assistants and allied health personnel that reimbursement for services performed by a physician assistant should be made directly to the responsible physician,” TMA wrote in a letter in February. “While greater use of nonphysician personnel can improve the system, responsibility for care must be clearly defined if various personnel are to work together effectively to provide high quality services for the patient.” 

TMA also urged UHC to provide further education to physicians and NPPs on proper incident-to billing. 

“As part of this effort, UHC should make it clear that physicians can continue to utilize advanced practice nurses and physician assistants under proper incident-to billing arrangements, even if the advanced practice nurse or physician assistant has their own NPI,” the letter says.  

TMA is setting up a meeting with UHC officials to discuss the policy, and will report on any updates in Texas Medicine Today

For more information on incident-to billing requirements, TMA has published a questions and answers document and billing guidelines.

Last Updated On

March 11, 2021

Originally Published On

March 11, 2021

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David Doolittle

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Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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