Three Major Private Payers Issue COVID-19 Policy Changes
UnitedHealthCare, Humana and Anthem issue HME-related guidance in response the Coronavirus pandemic. AAHomecare reports it is working with additional payers.
- By David Kopf
- Oct 06, 2020
Major commercial insurance payers UnitedHealthCare (UHC), Humana and Anthem have released policy changes to help HME providers continue serving patients during the COVID-19 public health emergency.
Additionally, the American Association for Homecare reports that its Payer Relations team has been working with other HME industry stakeholders to coordinate with private payers to obtain additional relief for providers during the pandemic.
UHC posted various provisions for prior authorization, reimbursement of disposable supplies and proof of delivery for Medicare Advantage, Medicaid and Individual and Group Market health plan members. The provisions concern claims with dates of delivery from March 31 to May 31.
UHC changes include:
- For all COVID-19 discharges to homecare requiring a respiratory assist device or a ventilator, the vendor can deliver on notification only to UHC for codes E0471, E0465, E0466 and E0467 for up to three months from time of delivery. Notification is requested and the claim must be submitted with the appropriate modifiers and diagnosis code (ICD-10). After the three-month period, a prior authorization will be required.
- For orders involving COVID-19-related oxygen requests, providers can deliver oxygen without prior authorization and don’t need to meet current clinical criteria.
- UHC is trying to eliminate face-to-face evaluation requirements for HME providers.
- For prior authorizations for services that were completed before Oct. 1, 2019, a new prior authorization is required. Providers may complete a face-to-face assessment via telehealth.
- For prior authorizations for services that were completed on Oct. 1, 2019, or later, UHC is extending prior authorizations through Sept. 30.
- For new DMEPOS prior authorizations, providers may complete a Face-To-Face assessment via telehealth.
- DMEPOS evaluation requirements remain in effect for complex rehab technology (CRT) and orthotics and prosthetics. However, vendors may use their own technology, if available, to minimize in-person contact.
- Prior authorization is not required for a DMEPOS repair when the claim uses the repair modifier.
- Consistent with existing policy, prior authorization is not required for breast pumps.
- To help maintain member supplies, UHC made changes to the reimbursement timeline on initial, second and remaining orders on various disposable supply codes.
- UHC no longer requires a physical signature from the patient for proof of delivery, but the provider must note the time and date of delivery and relationship to member, in addition to maintaining required documentation for follow-up requests.
Humana updated its policy changes in guidelines outlined on its COVID-19 Provider Website, as well as an announcement from William Shrank, M.D., MSHS, chief medical and corporate affairs officer for Humana.
Humana’s policy changes during the COVID-19 outbreak include:
- Humana is now covering short-term home oxygen for members with a COVID-19-related diagnosis.
- To negate community spread of the virus, HME providers should waive the proof-of-delivery signature for HME items delivered to members with a COVID-19-related diagnosis.
- Humana is waiving all out-of-pocket medical costs (co-pays, co-insurance, and deductibles) related to covered treatment for COVID-19 for enrollees of individual and Group Medicare Advantage plans, fully insured commercial members, Medicare Supplement, and Medicaid.
- The payer will temporarily reimburse for telehealth visits with participating/in-network providers at the same rate as in-office visits. For providers or members who don’t have access to secure video systems, we will temporarily accept telephone (audio-only) visits. These visits can be submitted and reimbursed as telehealth visits
- Effective April 1, Humana has suspended all medical records requests for pre-and post-paid claim review processes for individual and Group Medicare Advantage, Commercial Group, and Medicaid and will release any claims currently under medical record review as of April 1 and issue payment to providers. In analysis of this guideline, the American Association for Homecare underscored the fact that Humana has stated it might request medical records retrospectively once the suspension is lifted.
Anthem also released several new guidelines designed to expand coverage, including for HME. Some key guidelines:
- The payer is suspending select prior authorization requirements to help providers care for patients diagnosed with COVID-19. It is suspending prior authorization requirements for patient transfers, skilled nursing facilities, and use of medical equipment critical to COVID-19 treatment.
- It is also temporarily adjusting the approach to monitoring claims and audits.
Many of the various policy relaxations and new guidelines from UHC, Humana and Anthem come after outreach from AAHomecare’s Payer Relations team, HME providers and other industry stakeholders.
Additionally, AAHomecare’s payer relations team has been coordinating with senior staff at Aetna, Anthem, BCBS Association, BCBS of Michigan, Blue Shield of CA, CareCentrix, Centene, Healthnet, HighMark BCBS, and Kaiser.
“We will continue to reach out to these and other major payers to clarify their guidance and advocate for our policy recommendations,” a statement from the association noted.
About the Author
David Kopf is the Publisher HME Business, DME Pharmacy and Mobility Management magazines. He was Executive Editor of HME Business and DME Pharmacy from 2008 to 2023. Follow him on LinkedIn at linkedin.com/in/dkopf/ and on Twitter at @postacutenews.