United Healthcare has agreed to begin paying physicians separately for acute care services provided during a preventive medicine visit. The policy change, effective December 8, allows for partial payment (50% of contracted rate) of a problem focused evaluation and management (E&M) service when performed on the same day as a preventive E&M service for the same patient. Currently, United only reimburses physicians for one of the two procedures. CMA and others in organized medicine have been advocating for a change to this unfair payment policy for years.

Although this new payment policy was first announced in December 2006, its implementation has been repeatedly delayed. At CMA’s urging, United has agreed to make the new policy retroactive. Claims with dates of service of October 15 to December 7 will automatically be reprocessed. CMA does, however, encourage physicians to run their own reports and identify affected claims to ensure all claims are paid appropriately.

Click here read the announcement from United Healthcare on this policy change.

Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.