NEWS ALERT: Amid COVID-19 Pandemic UHC Announces Expansion of Telehealth Coverage

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Original story posted on: April 9, 2020

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The insurer giant is also waiving the audio-visual component requirement.  

The nation’s second-largest healthcare insurer announced this week that it is waiving telehealth site restrictions and audio-visual mandates amid the continuing COVID-19 pandemic.

UnitedHealthcare (UHC) made the announcement via an update to its online resource library on Wednesday, saying that it is waiving the Centers for Medicare & Medicaid Services (CMS) requirements for Medicare Advantage (MA), Medicaid, individual, and group market health plan members on dates of service extending back to March 18 and through June 18, 2020.

“Eligible care providers can bill for telehealth services performed using interactive audio-video or audio-only, except in the cases where we have explicitly denoted the need for interactive audio-video, such as with PT/OT/ST, while a patient is at home,” UHC said. “By removing the originating site and audio-video requirement, UnitedHealthcare has broadened access to telehealth services.”

The announcement comes amid a seismic, industry-wide shift to telehealth services for a range of medical needs. The number of COVID-19 cases in the U.S. rose to more than 425,000 on Thursday, ranking it first in the world in that category by a wide margin, while deaths approached 15,000.

UHC, which at a reported 9.3 percent market share ranks only behind Anthem, at 10.4 percent, among American health insurers, also noted that its other protocols in handling telehealth services will remain unchanged.

“UnitedHealthcare reimburses telehealth services according to its telehealth reimbursement policies. Depending on whether a claim is for a Medicare Advantage, Medicaid, or individual and group market health plan member, those policies require slightly different modifiers or place of service indicators for a telehealth claim to be reimbursed,” the company said. “These policy changes will allow you to simply bill for telehealth services performed while the patient is at home.”   

Cost sharing will also be waived for in-network telehealth services for COVID-19- and non-COVID-19 related visits, the company added. According to plan benefits, out-of-network providers may also qualify for telehealth; member benefit and cost sharing will apply, if applicable.

The announcement came as welcome news to the industry at large. The National Alliance of Medical Auditing Specialists (NAMAS) sent out an update to its membership, saying that they “continue to look for specific guidance on this issue from CMS.”

To review UHC’s announcement in its entirety, go online to https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-telehealth.html.

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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