For practice managers, healthcare providers, and owners, a crucial policy update from UnitedHealthcare Community Plan in Texas demands immediate attention. Starting May 1, 2025, the plan implements a significant change to its home health services policy, effective for all services billed under Place of Service (POS) 12 on or after July 1, 2024. Practices must prepare now to avoid compliance issues and payment delays.
Key Policy Change: Inpatient Overlap Restriction
Under the revised UnitedHealthcare home health services policy, providers will not receive reimbursement for home health services billed with POS 12 if the service dates overlap with an inpatient stay. This policy aligns directly with current CMS guidelines and aims to eliminate duplicate charges while improving billing accuracy. However, the policy specifies two important exceptions: the date of admission and the date of discharge are not considered overlapping. This distinction is vital for accurate day-to-day billing.
Critical Actions for Providers
To stay compliant and ensure smooth reimbursement, practices must take swift, proactive steps:
- Notify and Train Teams: First, make sure your entire billing and coding staff is immediately aware of this policy change. Additionally, schedule targeted training sessions to help your team understand how to apply the updated rules, especially regarding the exclusion of admission and discharge dates.
- Adjust Billing Workflows: Next, revise your billing workflows to automatically prevent claim submissions for services that fall within the inpatient stay periods. Specifically, flag POS 12 claims when cross-referencing patient admission and discharge records.
- Monitor and Audit Claims: Most importantly, conduct regular audits. Proactive auditing identifies any potential home health inpatient overlap errors before the claims reach the payer. This drastically reduces the risk of denied claims and lost revenue.
Conclusion
Understanding and implementing the home health inpatient overlap restriction is mandatory for continued compliance with UHC Texas. In summary, adjust your workflows now to secure uninterrupted revenue and meet the policy deadline.