Payor Updates August 3, 2018 Member Resource 1110 MEDICARE: For prroviders who participated in the Merit-based Incentive Payment System (MIPS) in 2017, the MIPS final score and performance feedback is available for review on the Quality Payment Program (QPP) website. For more information on understanding the MIPS performance feedback, the Centers for Medicare and Medicaid Services (CMS) has prepared a Performance Feedback Fact Sheet for providers. If you have questions about your performance feedback or MIPS final score, contact the Quality Payment Program at (866) 288-8292 (TTY: 877-715-6222) or QPP@cms.hhs.gov. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, a targeted review can be requested until September 30. CMS has prepared a Targeted Review Fact Sheet and Targeted Review User Guide to assist providers seeking to request a targeted review. UNITEDHEALTHCARE: Effective August 18, 2018, UnitedHealthcare (UHC) will now allow reimbursement for CPT code 99051 (Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) when billed with acute care services by a primary care physician (PCP). Previously, UHC did not provide reimbursement for CPT 99051, citing its "After Hours and Weekend Care" policy, which reimburses participating PCPs only for services that are outside their normal office routines as an alternative to more costly emergency room or urgent care center services. UHC had advised that reimbursement of CPT code 99051 failed to accomplish this purpose, but now recognizes the change in policy supports reimbursement for primary care practices with additional hours providing convenient access for members to see their own PCPs. Beginning October 1, 2018, UHC will now deny evaluation and management (E/M) services not meeting the CMS new patient definition in lieu of processing claims with an assumptive replacement established E/M code. Providers are reminded that CMS defines a "new patient" as an individual who did not receive any professional services from the physician/non-physician practitioner or another physician of the same specialty who belongs to the same group practice within the previous three years. Providers who experience denials may resubmit the appropriate level established E/M CPT or subsequent visit HCPCS code based on the service documented in the medical record. To determine which procedure code accurately reflects the services rendered, care providers should refer to the CMS 1995 or 1997 Evaluation and Management Guidelines.