Modern Healthcare reported that UnitedHealthcare (UHC) says that starting Jan. 1, it will only pay for remote patient monitoring for heart failure or hypertensive disorders of pregnancy.
Apparently, this was published in a September update to physicians, but I just learned of it thanks to the Nov. 10 Modern Healthcare article. The bulletin asserts that for conditions like chronic obstructive pulmonary disease (COPD), diabetes, and hypertension that are unrelated to pregnancy, remote monitoring is unproven, and not medically necessary. As a result, UHC will not cover it.
I have read the bulletin, and I will admit that I am a bit confused about exactly what UHC’s current position is with respect to the scope of patients to which the new policy will apply. The original reporting I saw indicated that this policy would apply to all patients insured by UHC, including Medicare Advantage (MA) patients. I am pretty certain that I saw a news story featuring a comment from UHC that the new policy was legal, but I can’t find that article now.
There are two reasons I want to mention this policy. The first is that this is a big deal. Remote monitoring is widely used. This change will affect patients and healthcare organizations. The second reason is that I don’t think there is a plausible argument that an MA plan can refuse to cover remote monitoring. I feel a little guilty covering this again, because we’ve seen many stories on the topic, but since it appears that major MA plans struggle to grasp the fact that MA plans have to cover everything that traditional Medicare covers, it bears repeating.
There is a federal regulation, 42 CFR § 422.101, that says with a few very limited exceptions that apply to some hospital care and hospice, every MA organization has to provide coverage by furnishing, arranging for, or making payment for “all services that are covered by Part A and Part B of Medicare and that are available to beneficiaries residing in the plan’s service area.” The regulation goes on to state that plans must comply with general coverage and benefit conditions included in traditional Medicare, unless superseded by laws applicable to MA plans.
The language is straightforward and clear. If traditional Medicare covers a service, MA plans must cover it as well. Traditional Medicare covers remote patient monitoring, so I am at a complete loss as to how UHC could think that they can apply this policy to their MA enrollees. But it appears that UHC may already recognize this reality.
The online version of the UHC policy has three different headings: one for commercial plans, one for individual exchange policies, and one for Medicare Advantage. When I click on the MA policy, I get a “404 page not found” error. It’s possible that someone within UHC recognized this relatively clear violation of MA regulations, and the company will only apply the policy on the commercial side. Ideally, there would be a direct statement on the website making this point, rather than a 404 error. But I suspect that is what is going on.
The bottom line is that while MA plans can be more generous than Medicare, under the law, they don’t have the ability to unilaterally limit coverage of service covered by traditional Medicare. Any limit on remote patient monitoring should not apply to MA patients unless Medicare adopts a limitation.
EDITOR’S NOTE:
The opinions expressed in this article are solely those of the author and do not necessarily represent the views or opinions of MedLearn Media. We provide a platform for diverse perspectives, but the content and opinions expressed herein are the author’s own. MedLearn Media does not endorse or guarantee the accuracy of the information presented. Readers are encouraged to critically evaluate the content and conduct their own research. Any actions taken based on this article are at the reader’s own discretion.
In the last six weeks, my colleagues and I have dealt with two situations in which clinics either missed or did not receive the orange
EDITOR’S NOTE: This article was originally published Monday, Dec. 8 by RACmonitor as a special bulletin. Many people are still seething mad about Aetna’s devious
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
