Developing: UnitedHealthcare and the Anatomy of Modifier “SA”

Announced in June by UnitedHealthcare (UHC), its new policy begs the question: “Are you adding the modifier correctly for UHC services for your qualified healthcare professional?” Below is the policy:

New Policy – Advanced Practice Health Care Professional Evaluation and Management Procedures Policy

Effective for claims with dates of service on or after Sept. 1, 2017, UnitedHealthcare will require physicians reporting evaluation and management (E/M) services on behalf of their employed Advanced Practice Health Care Professionals to report the services with a modifier to denote the services were provided in collaboration with a physician. UnitedHealthcare will accept the modifier SA on claims for these services when provided by nurse practitioners, physician assistants, and clinical nurse specialists.

This coming Monday, during the next edition of Monitor Mondays, special guest Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS), will report on how this policy will affect your claims.

The broadcast rundown also will include:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment.

• Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, will have all the latest news and the Monitor Mondays Listener Survey.

• Appeals Report: Denise Wilson, vice president at Denial Research Group and AppealMasters, will report on how to defend claims that have been denied for different issues, such as medical necessity and coding.

• America’s Rural Health Report: Topic authority Janelle Ali-Dinar, vice president of rural health for MyGenetx, will report on saving healthcare for rural populations.

• Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will have another example of a potentially troublesome issue that could pose a risk to your facility.

Register now for this special news broadcast coming your way on Monday, Sept. 25, 2017 at 10 a.m. ET.

Monitor with us.™

PROGRAM NOTE: Dedicated physicians need their evaluation and management (E/M) services accurately coded and documented in order to ward off investigations by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) and audits from third-party auditors. Coming soon will be an exclusive RACmonitor four-part, on-demand series on E&M that can help you protect your facility and physicians. Register now on the RAC University bookstore.