The Coronavirus Aid, Relief and Economic Security (CARES) Act is designed to provide relief to individuals and businesses impacted by COVID-19. Here is key information that applies to health care professionals and to claim payments.
As part of the CARES Act, the U.S. Department of Health and Human Services (HHS) is contracting with UnitedHealth Group to facilitate the delivery of HHS’ initial $30 billion distribution to providers as quickly as possible in support of the national response to COVID-19. For information, visit hhs.gov/providerrelief. For questions regarding the distribution of funds, please call the toll-free CARES Provider Relief line at 866-569-3522.
On March 27, 2020, President Donald Trump signed into law a $2 trillion bipartisan package called the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This act is designed to inject stimulus into the economy and provide relief to individuals and businesses impacted by COVID-19.
Here’s how UnitedHealthcare will apply the CARES Act increase in the DRG weighting factor to care provider payments.
For dates of service from Jan. 27, 2020 through the end of the national public health emergency period, Section 3710 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act increases the weighting factor applicable to the diagnosis-related group (DRG) by 20 percent under the Centers for Medicare & Medicaid Services (CMS) inpatient prospective payment system (IPPS) in the case of a discharge of an individual diagnosed with COVID-19. Due to a delay in CMS releasing necessary information related to the increase in this weighting factor, and to accelerate payment to care providers, UnitedHealthcare will process inpatient claims according to currently available information. Once CMS officially releases the updated weighting factor information, UnitedHealthcare will automatically reprocess the impacted claims. No action is required by care providers to initiate the reprocessing.
Contracted Care Providers: UnitedHealthcare will pay care providers according to the terms of their participation agreement. For care providers who treat Medicare Advantage members and whose contracted reimbursement is based upon CMS IPPS reimbursement methodology, we will apply the increase, as appropriate, for discharges of individuals diagnosed with COVID-19 during the national public health emergency period. Care providers are required to comply with CMS coding and billing requirements.
Out-of-Network Care Providers: UnitedHealthcare will apply the Medicare COVID-19 add-on payment for inpatient stays to payments to out-of-network care providers who treat Medicare Advantage members. For out-of-network providers who treat Medicare Advantage members, we will comply with CMS requirements and apply the increase, as appropriate, for discharges of individuals diagnosed with COVID-19 during the national public health emergency period. Care providers are required to comply with CMS coding and billing requirements. For a care provider who treats commercial or Medicaid members, we will pay for covered services in accordance with the member’s health plan benefits and applicable laws and regulations.
Medicaid and Individual and Group Market (Commercial) Health Plans
UnitedHealthcare pays contracted facilities according to the terms of their participation agreement. Facilities in our Medicaid and Individual and Group Market Health Plan (commercial) networks may be contracted based on several payment methodologies, including the MS-DRG payment method. As applied to providers in the Medicaid and Individual and Group Market Health Plan (commercial) networks, this payment method does not follow the CMS IPPS payment method. The payment appendices do not include add-on payments in the calculation of the contract rate. Providers in our Medicaid and Individual and Group Market Health Plan (commercial) networks are not entitled to the CARES Act 20% add-on payment under the terms of their participation agreement.
The temporary waiver of the Medicare Sequester adjustment for claim payments ended on March 31, 2022. This applies to physicians, facilities and other health care professionals who:
Provide services to Medicare Advantage plan members, including Medicare Advantage Dual Special Needs Plans (DSNP) and
Whose reimbursement is based on current year Medicare reimbursement methodology or rates
2022 sequestration details The sequester resumed on April 1, 2022, as follows:
From April 1, 2022, through June 30, 2022, the sequestration rate will be 1%
Beginning July 1, 2022, the sequestration rate will be 2%, unless otherwise adjusted before this date
Impact to contracted and out-of-network care providers
For contracted Medicare Advantage providers, UnitedHealthcare will implement the sequester according to the terms of care provider participation agreements and in the same manner that was in effect prior to the waiver
For out-of-network care providers, UnitedHealthcare will resume reimbursement in the manner that was in effect prior to the implementation of the waiver
Capitated groups Capitated groups who are delegated for claims payment should review their direct contracts with downstream care providers to determine how their payment methodologies and rates relate to Medicare methodology and rates, and to determine the impact of the end of the waiver. If you have questions, please contact your network representative.
COVID-19 sequestration waiver details Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act created a temporary waiver of the Medicare Sequester.
The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.