The Advocacy Council is aware many practices have experienced devastating fallout from the Change Healthcare cyberattack – an issue directly affecting cash flow that may threaten payrolls for many and the very survival of some practices. We are following this situation closely on your behalf; following are updates from Medicare, UnitedHealth Group, and HHS.
MEDICARE
CMS announced new advanced payment financial assistance programs for providers whose revenues were impacted by the Change Healthcare cyberattack. All MACs will provide public information on how to submit a request for a Medicare accelerated or advance payment on their websites as early as Saturday, March 9. Providers are eligible for 30 days of Medicare payments based on the total claims paid to the Part A Providers/Part B Suppliers between Aug. 1, 2023, and Oct. 31, 2023, divided by three. These payments will be repaid through automatic recoupment from Medicare claims for a period of 90 days. A demand will be issued for any remaining balance on day 91 following the issuance of the accelerated or advance payment. Contact your MAC for more information.
UNITEDHEALTH GROUP
Here is the latest update from UnitedHealth Group (UHG).We encourage you to bookmark and check the UHG site regularly for updates.
Claims
Change Healthcare expects to begin testing and reestablish connectivity to their claims network and software on March 18, restoring service through that week.
In the interim, 90% of claims are being processed due to workarounds, but there are still a number of providers who are unable to submit claims or receive payment.
For payers exclusive to the Change clearinghouse, UHG is mobilizing a new temporary solution to move the Change gateway claims connection to an Optum electronic data interchange (EDI) claims connection. Their strong recommendation is for providers and revenue cycle vendors to connect to the new temporary secure EDI option. UHG began hosting an ongoing series of webinars on EDI to assist providers with this change.
If you want to receive support regarding moving to Optum’s new EDI claims connections, please connect with your UHG account team or contact them via email.
Payment
Electronic payment functionality is expected to be available for connection beginning March 15. Optum Financial Services has established a temporary funding assistance program to help with short-term cash flow needs for physicians who receive payments from payers that were processed by Change Healthcare. There are no fees or interest associated with this program. These weekly payments will not automatically renew; instead, physicians must elect to accept funding each week.
Additionally, UnitedHealthcare will provide further funding solutions for its medical provider partners. This will involve advancing funds each week, representing the difference between their historical payment levels and the payment levels post-attack. Advances will not need to be repaid until claims flows have fully resumed. Providers must complete a one-time registration to access funding.
Finally, Optum is expanding its funding program to include providers who have exhausted all available connection options, and who work with a payer who has opted not to advance funds to providers during the period when Change Healthcare systems remain down. This is a funding mechanism of last resort designed for small and regional providers and will be evaluated on a case-by-case basis.
Prior Authorizations
For Medicare Advantage plans, UHG is temporarily suspending prior authorizations for most outpatient services except for Durable Medical Equipment, cosmetic procedures and Part B step therapies. For Medicare Part D pharmacy benefits, they are temporarily suspending drug formulary exception review processes. These actions will remain in place until March 31.
Pharmacies
Electronic prescribing is now fully functional with claim submission and payment transmission also available. However, infusion pharmacies and specialty coupons managed by Change Healthcare continue to be impacted.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
HHS recently released a statement in response to stakeholders’ concerns about the inability to submit claims and receive payments from those affected by the Change Healthcare cyberattack. HHS has heard these concerns and is taking direct action to support the important needs of the health care community. Flexibilities outlined in the statement include:
- Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and be ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.
- CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.
- CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by each state.
- If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.
- CMS has contacted all MACs to make sure they are prepared to accept paper claims from providers who need to file them. MACs must accept paper submissions if a provider needs to file claims in that method.
HHS also encouraged all providers, technology vendors, and members of the health care ecosystem to double down on cybersecurity to avoid further disruptions. Please visit the HPH Cyber Performance Goals website for more details on steps to stay protected.
Proactively implementing these strategies can help stabilize your practice financially and operationally in the short term. However, additional efforts may be needed for many practices to survive the lasting impacts of a prolonged outage.
Practices should continue to actively inquire and stay apprised of any state or federal emergency relief programs for practices affected by the cyberattack. They should also collaborate and stay apprised of state and federal advocacy efforts on behalf of medical practices.
MGMA published an article on emergency cashflow management during the Change Healthcare crisis that provides additional strategies.
We will continue to closely monitor and keep members informed of the ongoing responses to the cyberattack.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
