September 27, 2022
UnitedHealthcare (UHC) in August announced it would begin migrating some physicians to an updated commercial fee schedule beginning in October 2022. As part of the first stage of this transition, UHC issued a Notice of Amendment to approximately 3,000 providers tied to the UHC 2008 commercial fee schedule. Half those providers notified may not, however, actually be impacted by the first phase of the fee schedule update.
UHC recently issued a revised mailing to approximately one third of the 3,000 providers previously notified to inform them of the error, and informing them to disregard the previous notice. Providers in receipt of the new mailing will have their fee schedule effective date delayed until December 15, 2022. Providers who did not receive a corrected mailing will continue to have an effective date of October 15, 2022, for their fee schedule change.
The fee schedule update, slated to occur in several phases between October 2022 and January 2023, will move physicians on older fee schedules dating back to 2008 to a new 2020 UHC commercial fee schedule based on 2020 CMS RVU values.
As part of the notification to providers about the fee schedule transition, providers will receive a UHC Notice of Amendment, samples of the new fee schedule for reference and a new Payment Appendix to be attached to the provider’s existing UnitedHealthcare participation agreement.
Physicians do not need to sign or return the contract amendment to UnitedHealthcare for the fee schedule changes to take effect. However, providers who would like additional information regarding this change, object to the amendment, wish to terminate their entire agreement with UnitedHealthcare, or want to confirm whether their practice is affected should contact their Network Account Manager directly or email UHC at email@example.com.
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts CMA has developed a simple worksheet that will help physicians analyze the impact fee schedule changes may have on their practices based on commonly billed CPT Code. CMA’s Financial Impact Worksheet is available free to CMA members on our website.
The California Medical Association (CMA) reminds physicians that they do not have to accept substandard contracts that are not beneficial to their practice.
To help physicians understand their rights when a health plan has sent notice of a material change to a contract, CMA has published "Contract Amendments: an Action Guide for Physicians." The guide includes a discussion of options available to physicians when presented with a material change to a contract.
Contact: CMA's reimbursement helpline, (888)401-5911 or firstname.lastname@example.org.