Good Morning All,
I would like to thank both Michelle Jones and Lesleigh Sisson for the link
to the UnitedHealthcare manual. I am aware United is required to follow the
Medicare guidelines. I was asking for United’s written policy to include in
my appeal. I found the information here with their help. For those of you
who asked me to post the information you can find it here:
https://urldefense.proofpoint.com/v2/url?u=https-3A__www.uhcprovider.com_content_dam_provider_docs_public_policies_medadv&d=DwICAg&c=pZJPUDQ3SB9JplYbifm4nt2lEVG5pWx2KikqINpWlZM&r=pVyaAUHOR6gxxThvjGI9X7hrz_ONYByMAadML4fTENI&m=G64_ZM18bEufEDg4nBbAeDUEkHgHuF-36onzQOXnd9w&s=iIEQWJxcyIHeFv1xFB01eZRx9LYhUQ4dpBk-nspp9Hg&e=
-coverage-sum/skilled-nursing-facility-snf-care-exhaustion-snf-benefits.pdf
Click on # 4. Covered services under part A, scroll to page 13 section 4. i.
Certain customized prosthetic devices.
Note: These services can be considered for payment separately under Part B
during a covered Part A SNF stay since items a. through j. are excluded from
the PPS consolidated billing methodology.
I clicked the blue hyperlink to Medicare Benefit policy, Chapter 8 Medicare
SNF Coverage Guideline under PPS. I Scrolled to page 51 section 70 and got a
little confused about coverage. However, I believe page 13 makes our case
that the codes billed are exempt from the consolidated billing and are
billable and payable.
Have a good day,
Cindy
749 Hope Road, Suite C
Eatontown, NJ 07724
(732) 380- 0366 Phone
(732) 380-0245 Fax