UHC Fee Schedule Cuts

January 8, 2021

The last few days of 2020 brought some good news to many physicians, as Congress intervened and staved off a large portion of cuts expected on the Medicare Physician Fee Schedule for 2021. During the same period, APS has started to receive notification of reimbursement rate cuts looming from another carrier, United Healthcare (UHC). APS is releasing this White Paper as time sensitive due to the need for immediate action from our client base. 

Notification of cuts to UHC started trickling into the APS Client Services Team the last week of December, 2020 and have continued through the first week of 2021. These are coming to clients in the form of a certified letter, but our concern is if they are actually finding their way to all clients affected. In most cases, the letters are being sent directly to clients but at the facility’s address rather than your remit address. This means that we are reliant on the facility staff to direct the letters to the correct physician or their staff and further notify APS.

The letters indicate a “Notice of Material Change to Your Contract,” which takes effect 3/15/2021. The letters have all been dated 12/15/2020 and allow for just 30 days to review, object and determine if going out of network is necessary due to the severity of the cuts. This makes Friday January 15, 2021 the last date to respond, if your Tax ID received a letter. Failure to respond will be considered acceptance of the rates. 

APS has written programming to run quick analysis of the impact, if any, to the reimbursement rates indicated in the letters based off 2020 claims data. Further, we have reached out to the carrier to ask for a listing of all clients that received a letter, to help with our concerns over client’s receipt of the letters through hospital mail workflows. We do not currently have a response from the carrier, so we are urging our client base to reach out proactively within their health system to ensure any certified letter was/is sent to their attention expeditiously. 

APS will continue running these analyses and share impact with each client upon receipt of each letter.