In 2011 United Healthcare implemented 5 changes to its reimbursement policy in an ongoing effort to lower costs and improve consistency in its medical billing procedures. We believe these changes to our reimbursement policy support the first objective in our mission statement:

  •  We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities.

Working to more closely reflect the polices and procedures of the CMS (Centers for Medicare and Medicaid Services), United Healthcare believes that the following changes will result in lower costs and improved consistency.

1) Change to our S/U Modifier policy: The code “S/U” is used to denote that a procedure was performed in an office setting, and denotes the use of that facility and its equipment. Based on the CMS guidelines, we will no longer reimburse physicians for any procedure where the S/U modifier code is used; rather, the physician should submit his/her bill without the S/U modifier.

2) A Revised CCI Editing Policy: Implementation of mutually exclusive edits that aren’t presently utilized in our billing procedures. Aligning with CMS guidelines we will now reimburse for the code with the lower RVU (Relative Value Unit) value when determining how much to reimburse the physician for services.

3) Updating our Rebundling Policy: In 2011 we introduced separate edits that deny reimbursement for an E/M (Evaluation and Management) code that appears with a non E/M code on the same day of service by the same provider, unless the modifier 25 is present, indicating it is a separate and distinct procedure or service.

4) Change to our Multiple Imaging Reduction Payment Policy: United Healthcare will now align its multiple imaging reimbursement policy to mirror CMS guidelines for multiple imaging payment methodology, treating services as if they are coming from the same diagnostic family.

5) Retirement of the Viral Hepatitis Reimbursement Policy:  This policy will be retired and claims edits removed for dates of service subsequent to May 15, 2011 for viral testing services.