Hospitals Wave Red Flags as UnitedHealthcare ED Policy Takes Effect

Hospitals Wave Red Flags as UnitedHealthcare ED Policy Takes Effect

UnitedHealthcare (UHC) just launched a new protocol for evaluating emergency room claims that it says will encourage accurate coding by providers and ultimately bring down healthcare costs. Some hospitals view it as just another way to deny claims, however—and one that could actually end up costing patients more money, at that. Under the policy that took effect on March 1, UHC reviews and maintains the right to adjust or deny claims for ED visits coded …

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Are You Maximizing Claims on Radiology, Pathology, and E/M Services?

Are You Maximizing Claims on Radiology, Pathology, and E/M Services?

Date-of-services rules can be cumbersome on a good day—and can even turn an otherwise good day into a major headache for coders. A Medicare administrator contractor (MAC) put forth a provider outreach and education (POE) recommendation recently aimed at leveling out that “uphill battle” when it comes to complying with date-of-service requirements. An article in published online by DecisionHealth recommends clarifying the specific date-of-service rules your urgent care center follows when reporting common radiology, pathology, …

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