Has UHC ER Attestation Policy for Emergency Room Medical Billing gone too far?

In early June, UHC announced a surprising new ‘Non-Emergent’ policy for Emergency Room use. In recent years, UHC has been stricter in billing of ER visits, in what some may say is a realistic need to drive down unnecessary Emergency Room use. In MedPage Today, UHC quoted misuse of the ER as costing the healthcare industry and consumers nearly $32 billion annually. While the growing need for patient education in proper place of service care is prevalent; UHC challenges the Medical Community with new policies intending to punish providers for simply providing mandatory care in Emergency settings.

In the past, UHC has been firm about requesting records and additional documentation for ER claims they deem may not have been emergent. While this policy has put an unfair burden on providers who are required to treat patients by asking them to submit records on a majority of the claims for their members, it still left providers with a way to prove the need for care, or to be able to detail why the patient felt they needed emergency care.

This new policy, which UHC has temporarily delayed due to increasing backlash from the medical community, would require the treating physician to not only treat the patient – but then to go back after the claim has already been billed and have them detail the emergency need; the same emergency need that is generally well defined in the medical records in the first place. Is this because their own policy for requesting records on ER claims has become too much for even them to handle? While unconfirmed, it does seem like UHC is moving to this new process as a way to get around the manual labor it requires reviewing the records that define the emergency need in order to push the additional burden on the provider.

While no one can deny the increased non-emergent use of the emergency room in recent years, it seems in order to correct this problem. UHC should be focusing its efforts on Patient Education. Emergency Room Providers have an ethical duty and are required by law to stabilize and treat any emergency patient; however, UHC seems more and more intent on punishing them for holding to their code of ethics – which could potentially be violating some state laws by pressuring providers for rendering treatment based off Prudent Layperson Standards.

Here at 360 Medical Billing Solutions we are dedicated to the fight against provider penalization and are working alongside the AMA, ACEP, and local State Agencies to mitigate the damages this new Attestation policy could hazard. While UHC has temporarily halted the implementation due to the COVID19 Pandemic, they are likely to try and review it again as quickly as possible. As a valuable partner, 360 Medical Billing Solutions will be here to fight every inch for our providers right to treat.

Request a free no-obligation consultation. Find out how 360 Medical Billing Solutions can help you maximize your medical billing revenue and cash flow from strategies that reduce claim denials and maximize reimbursements. Contact us on our website or call 1-405-607-1318.