United Healthcare Medicare

United Healthcare Medicare

Cindy Anderson

9/24/2018

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:


 
< <URL Redacted>
v-coverage-sum/skilled-nursing-facility-snf-care-exhaustion-snf-benefits.pdf
>
<URL Redacted>
-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

<Email Address Redacted> <mailto:<Email Address Redacted>>



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