Select Medicare claims eligible for inpatient payment

Last update: October 15, 2021

Effective Nov. 1, 2021, UnitedHealthcare is accepting the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home program waiver for qualifying Medicare claims. We will accept the waiver from Nov. 1, 2021 through the last day of the COVID-19 national public health emergency period, when it is announced.

Facility participation requirements

To participate in the Acute Hospital Care at Home program with UnitedHealthcare, facilities must have: 

  • A participation agreement with UnitedHealthcare for the in-scope benefit plans noted below
  • A waiver from CMS to provide Acute Hospital at Home services to Medicare beneficiaries

Eligible health plans

The following UnitedHealthcare plans are in scope for participation in Acute Hospital Care at Home:

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

The following UnitedHealthcare plans are out of scope for participation in Acute Hospital Care at Home:

  • Individual Exchange
  • Individual and Group Market

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 Home webpage or visit UHCprovider.com/COVID19.  

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