Select Medicare Advantage claims eligible for inpatient payment

Last update: October 2, 2023

Acute Hospital Care at Home

To help more members receive care at a time when many hospitals are overburdened, UnitedHealthcare is accepting the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home program waiver for qualifying claims in the following benefit plans:

• Medicare Advantage
• Medicare Advantage Special Needs plans, including Dual Eligible Special Needs (DSNP)
• Group Medicare Advantage 
• Medicaid plans only if mandated by state law or regulations

We will accept the waiver for qualifying claims:

• Services are provided by a facility that has received a waiver from CMS
• Claims with a date(s) of service from Nov. 1, 2021 through Dec. 31, 2024 as outlined within the Consolidated Appropriations Act (CAA) signed into law on Dec. 29, 2022.

Please review the information below for details. If you have specific billing or claims questions, please contact your Provider Advocate or Network Engagement Manager.

Program background

The Acute Hospital Care at Home program was designed help more patients receive care at a time when many hospitals are overburdened due to the COVID-19 national public health emergency. To facilitate the goal of increasing hospital capacity and improving resource allocation, CMS waived a previous Medicare Conditions of Participation requirement. This allows qualifying hospitals to receive inpatient payment for providing acute inpatient level of care services to Medicare beneficiaries in their homes.

Questions?

For detailed billing guidance on this initiative, review the Acute Hospital Care at Homeopen_in_new webpage or visit UHCprovider.com/COVID19.  

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