UnitedHealth Group offers products and services through two operating businesses, UnitedHealthcare and Optum, both subsidiaries of UnitedHealth Group.
Optum include three divisions:
- OptumInsight – Health Data Analytic, Payment Integrity, Life Science, Risk Quality & Network Solutions, Medical Billing
- OptumRx – Pharmacy Benefit Manager (now includes all Unitedhealthcare membership) and Catamaran acquisition
- OptumHealth – Healthcare delivery services and support including Consumer Solution Group and OptumCare (Behavioral Health and Substance Abuse, Dental, Vision, Transplant Management, and other ancillary services)
OptumHealth Care Solutions processes outpatient therapy claims and OptumHealth Care Solutions have several reimbursement policies pertaining to outpatient physical, occupational and speech therapy services. Three of the most frequent questions I receive regarding OptumHealth Care Solutions is:
- Do they follow Medicare’s billing guidelines (i.e. 8-minute rule)
- Do they limit how many time-based units they pay for on a given treatment day
- Do their policies also apply to me if I am an out-of-network provider.
In this article, I will answer these 3 questions and provide you with the resource and reference for my answers.
Does OptumHealth Care Solutions follow Medicare’s billing guidelines?
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.