Payer: UnitedHealthcare
Plan Type: UnitedHealthcare Community Plan
Service Type: Home Health Service Policy, Professional
State: Texas
Effective Date: May 1, 2025
Starting May 1, 2025, UnitedHealthcare Community Plan in Texas will implement a new Home Health Services Policy for dates of service on or after July 1, 2024. This policy affects home health services billed under place of service (POS) 12.
Key Policy Change
In alignment with CMS guidelines, UHC will not reimburse home health services billed with POS 12 if the service dates overlap with an inpatient stay. Importantly, the policy excludes the date of admission and discharge from the overlap rule.
What This Means for Providers
Practice managers and billing teams should take the following actions to ensure compliance:
- Notify billing and coding teams about the policy change and how it impacts billing for POS 12.
- Adjust billing practices to avoid submitting claims during an inpatient overlap period.
- Provide training to ensure accurate application of the policy in everyday operations.
- Continuously monitor coding and billing processes to avoid denied claims and revenue loss.
By updating your procedures and educating your staff, your practice can stay aligned with UHC’s requirements and prevent reimbursement delays or denials.