UnitedHealthcare Updated Therapy Policy: July 2023
Update: On July 26, 2023, I published an updated article regarding UnitedHealthcare’s Habilitation and Rehabilitation Outpatient Therapy Medical Policy. Click HERE to read that update.
On June 5, 2023, I published an article titled “UnitedHealthcare July 2023 Medical Policy Update“. This article provided you with a direct link to UnitedHealthcare’s revised Habilitation and Rehabilitation Therapy (Occupational, Physical and Speech) revised medical policy. As many of you have read, UnitedHealthcare (UHC) has instituted some major changes to this medical policy. In this article, I will specifically address some of the significant changes.
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We are not in network with UHC, do we still have to follow these rules?
If the patient has OON and UHC is paying you, I would say yes.
UGH….Thank You
Thanks Rick. Is UHC requiring that the plan of care be recertified every 90 days or just the initial plan of care requires certification?
UHC does not address a recertification in this revised policy.
Does each SOAP note need to be signed as well or just the evaluations, reevaluations and discharges?
Please read the answer to “What Must Be Included in Treatment Note”.
Has UHC addressed the timeframe or grace period window to obtain a signature? Or will they not Auth the 2nd visit without a signed POC?
They have not.
UHC does not require a referral, how do you get a POC signed?
Same as you would do for Medicare. You would need to send to the patient’s physician.
Does the POC need to be signed prior to starting treatment?
UHC does not state the timeframe for obtaining the signed POC.
Should we do an updated POC on our current UHC and have it signed or will they grandfather those in?
Thanks
Please read updated article addressing your question.
If have existing clients with UHC, do we need to get a signed POC before we continue to see them?
Does this apply to patients who have UHC but therapy benefits process through Optum or UMR?
Please read updated article addressing your first question. This policy applies to all UHC Commercial Plans.
What about Direct Access patients with UHC? Does this now mean that UHC patients cannot be Direct Access?
Please read updated article addressing your question.
How does this work with these policies being in conflict with Optum policies?
This policy applies to all UHC Commercial Plans so if the patient’s plan is UHC Commercial, I would follow this policy.
Are PT’s considered appropriate specialist? We always sign and date or POC or do we still need to send the notes to the referring doc for signature?
PTs are not considered appropriate specialists as of now.
Can you clarify “Start and stop time in treatment”?
Time therapy starts and time therapy ends.
Does this POC have to be signed within 30 days like Medicare? Do they require a signed POC every 90 days like Medicare? Thank you!
UHC only mentions the initial POC requirement.
Hi Rick, on the bottom of page 2 on the 07.01.2023 policy, under re-evaluations, this is stated “the updated POC/progress summary must not be older than 90 days”. Can you please help interpret if that means to update the POC every 90 days in prep for the re-evaluation that’s required once every 12 months? Thanks!
HI–does this apply to private practices as well as hospital outpatient PT (UB04 as well as HCFA 1500 forms)?
This policy applies to all UHC Commercial plans.
Rick,
Do you know if any of this applies to a UHC Managed care policy? I am thinking not but just not 100% sure.
Thank you,
Matt Mesibov
This policy does not apply to UHC MA as UHC MA has their own policies.
No question just a comment. UHC is deliberately and intentionally putting up more barriers and administrative burdens to limit patient access. Essentially they are attempting to ration care without calling it rationing. This is a tactic other payers are using as well. Hardly fair when therapists are already burdened with too many rules and regs. So they adapt CMS policies they know are burdensome to add more layers of bureacracy. How do they expect patients to get the care and treatment they need? The fact is they could care less. Just as long as they keep pulling in record profits Wall St investors will be happy. Not what this noble profession needs.
Rick
Does Optum follow the UHC rules?
If the patient’s insurance is a UHC Commercial Plan, I would tell you to follow this policy.
So if we do not get a script or POC signed, does that mean that UHC will not pay for the visit? Is a signed script for the ref Dr. considered the same as getting the POC IE or RE letter signed?
A physician script will not contain all the required elements of a plan of care.
Are these updates regarding Outpatient Therapy services only?
In my opinion, yes.
Hi Rick. Is it required to put time in/out for these UHC patients?
Sam
Please read the article for the answer to your question.
Under Plan of Care requirements, the last bullet point states, “Treatment frequency, duration, and anticipated length of treatment session(s).” What is the anticipated length of treatment session(s) referring to for what must be included?
That would be a question to ask UHC as it could be interpreted several ways.
Hi Rick,
I have read through all the questions and answers, but just for clarification, we have patients with UMR and All Savers which are a part of the UHC Network, so would these insurance plans neen to follow suit?
The policy applies to all UHC Commercial plans and most UHC Individual Exchange plans. It does not apply to MA or Medicaid plans.
Does this apply to UHC when they are secondary?
I would tell you to follow the primary.
Regarding the start and stop time. I just spoke with a rep from UHC and they are stating that they want the start and stop time for each therapy performed during an appt. I was thinking it was the start of the appt and the stop time of the appt.
With regard to “anticipated length of treatment session(s)” in the POC, is it acceptable to report a range (i.e. “30-60 minutes” or “up to 60 minutes”)?