Signal of the Day · SNF / Post-Acute
UHC Prior Authorization Reductions Will Have Little Impact on SNFs and HHAs
LeadingAge's Sept. 3 analysis finds few of UnitedHealthcare's removed codes reach skilled nursing or home health, and raises the governance question that matters more than the count: if authorization is dropped at the front door, the burden of proving medical necessity may simply move to claim submission, where automated payment-integrity adjudication carries far less disclosure, timing and appeal protection than prior authorization does. Verification against the payer's own removal lists sharpens the picture — the Medicare Advantage and D-SNP file contains 70 distinct codes, not 1,700 (the roughly 1,000-code volume sits in a state-by-state Community Plan file that is largely surgical), CPT 92507 rather than 92597 appears on it, and 92526 was removed for Medicare Advantage but not for D-SNP. The central finding holds: the list carries only CPT and HCPCS Level II codes, with no revenue codes, no G-codes and no SNF admission or home-health episode codes, so nothing in it removes authorization for a nursing home stay. Post-acute operators should read prior-authorization reduction as a relocation of algorithmic decision-making, not a reduction of it.