In CMS
Nov 13th, 2018
Proton therapy has been a tough sell for payers, but recent $25 million Oklahoma decision against Aetna may make them reconsider coverage for the spreading radiation therapy technique. Proton Tx Considered Best Choice According to the Associated Press, jurors believed Aetna reckless disregarded its duty to deal fairly and in good faith with Orrana Cunningham.  ...
Oct 10th, 2018
UnitedHealthcare (UHC) has issued a clarification to its Skin and Soft Tissue Substitutes medical policy (2018T0592A) in regards to DermACELL®. Behind the Decision DermACELL® (LifeNet Health®) is advanced human acellular dermal matrix intended for the treatment of chronic wounds and soft tissue reconstruction such as implant-based breast reconstruction. A recent report for DermACELL concluded that ...
In Billing
Dec 28th, 2017
In August 2017, UnitedHealthcare (UHC) indicated they would no longer reimburse inpatient and outpatient consultation codes, as of Oct. 1, 2017. When the implementation date came, UHC indicated they would delay the consultation services revision until 2018: We previously announced that certain revisions to the Consultation Services Reimbursement Policy would become effective for UnitedHealthcare Co...
Sep 10th, 2012
Ready or not, ICD-10 is happening. Implementation of the expanded diagnosis code set may be two years away, but at least one insurer isn’t letting the grass grow under its feet. UnitedHealthcare is hard at work updating its medical and drug policies and coverage determination guidelines with applicable ICD-10 codes in preparation for the transition ...
In Billing
Jul 13th, 2012
If UnitedHealthcare is among your list of payers, you’ll want to take note of several policy updates the insurer says it will implement on or before the fourth quarter of 2012. From prior authorization changes to supply codes no longer separately payable, the July 2012 Network Bulletin is a must-read. Here are the highlights: Notification ...