Overview

Did you know that providers across the nation are facing a daunting reality after the Change Healthcare cyberattack?  According to a recent analysis by Kodiak Solutions, claims to payers have dropped by more than one-third. But that’s not all – with a staggering $6.3 billion in delayed payments spread across 1,850 hospitals and 250,000 physicians. Beyond the immediate financial strain, this attack may also lead to increased claim denials due to delays in filing. Hospitals surveyed by the American Hospital Association reported that 60% of them experienced a daily revenue impact of $1 million or more.

There is a clear need for solutions to help healthcare providers recover from this multi-billion dollar financial blow and ensure the continued delivery of essential medical services. CMS is actively working on this. Fortunately, there are steps you can take to mitigate the impact of the attack and get back on track:

Recover Lost Funds: Relief Efforts for Impacted Providers

The Change Healthcare cyberattack has inflicted a significant financial blow on the healthcare industry. Several government and industry initiatives are stepping up to offer financial assistance to struggling healthcare providers. Here’s a breakdown of the available resources:

CMS Guidance on Medicaid Flexibilities in Response to Change Healthcare Cyberattack

Recognizing the disruption caused by the cyberattack, CMS is offering relief to Medicaid providers through a two-pronged approach:

1. Interim Payments

On March 15, 2024, CMS issued an informational bulletin outlining a program for states to provide interim payments to Medicaid fee-for-service providers. CMS further adds that interim payments should use the current rates set by the state plan and are limited to the expected use of allowed services based on how often providers have recently used them. It’s important to know that these are not advance payments. Interim payments must be sorted out after things are back to normal. Also, states have to follow all the rules for documentation, including making payments for allowed services that were affected by the Change Healthcare cyberattack.

• Purpose: This program aims to mitigate the cash flow strain caused by the disruption in claims processing and prevent disruptions in access to care for Medicaid beneficiaries.
• State Action Required: Individual states need to submit a state plan amendment (SPA) for expedited CMS approval. The SPA should detail:
  A methodology for calculating interim payments based on current state plan rates and historical provider utilization data.
  A process for reconciling these interim payments will be established once claims processing functionality is restored.
• Timeline for States to Follow: States are encouraged to submit SPAs by March 31, 2024, or notify CMS of their intent by April 10, 2024.
• Funding: States can draw down federal matching funds once a SPA is submitted and approved.
  The interim payment methodology can be applied retroactively to the first date of the cyberattack disruption but must sunset by June 30, 2024.

Benefits for Medicaid Beneficiaries After SPA Approval:

Uninterrupted Access to Care: By ensuring continued financial stability for providers, the SPA program helps prevent disruptions in access to care for Medicaid beneficiaries.

Reduced Administrative Burden: By expediting the SPA approval process, CMS aims to minimize delays in getting the available financial resources to providers, ultimately benefiting beneficiaries who rely on Medicaid services.

Additional Actions Encouraged by CMS:

States can temporarily suspend cost-sharing requirements for Medicaid beneficiaries while the SPA approval process is underway. CMS encourages states to work with Medicaid managed care organizations to provide interim payments to providers and implement additional flexibilities like:

1. Suspending or modifying prior authorization requirements.
2. Allowing early prescription refills or extending refill lengths.
3. Suspending out-of-network requirements.
4. Modifying existing cost-sharing requirements to align with changes made to the Medicaid state plan.

Important Points for Providers to Take Action On:

• CMS is still finalizing specific application processes and details regarding eligibility criteria and amounts for interim payments. So, providers should stay active and continuously follow CMS updates.
• States have some flexibility in designing their interim payment methodologies, and these designs will follow CMS guidelines. All states will design their own methodologies according to the guidelines. Providers may need professional assistance to understand their state’s interim payment plan. They can consult medical billing companies to get assistance promptly.
• While changes to Medicaid managed care programs typically don’t require a SPA, contract amendments might be necessary. Healthcare providers must be informed about these amendments in order to avoid any inconvenience or rejections.

CMS’s Change Healthcare/Optum Payment Disruption Program:

For providers impacted by Medicare disruptions, the Centers for Medicare & Medicaid Services (CMS) announced a program offering accelerated and advanced payments. Details and application procedures can be found by contacting your Medicare Administrative Contractor. This comprehensive approach aims to ensure uninterrupted patient care during this challenging time. The details for this program are:

Part A providers can receive accelerated payments, while Part B suppliers can receive advance payments. Providers and suppliers who qualify can get early payments called CHOPD accelerated and advance payments. These payments can be as much as what they’d typically receive for 30 days of claims. To figure out the average, they look at the total claims paid to the provider or supplier from August 1, 2023, to October 31, 2023, and divide that number by three. The money they get will be taken back from future Medicare claims over 90 days through automatic recoupment. Get the details here!

While CMS monitors the situation, it is suggested that providers should also explore short-term funding programs offered by other payers. CMS also encourages insurers to offer aid and reminds everyone to check their liability insurance coverage for potential protection.

2. HHS & Dol Encouragement Call on UHG

In a positive development, the Departments of Health and Human Services (HHS) and Labor (DOL) pressured UnitedHealth Group, owner of Change Healthcare, to expedite payments to providers impacted by the cyberattack and provide more transparent communication. Additionally, they urged all payers to offer interim payments, reduce administrative burdens, and temporarily suspend prior authorization requirements. The American Hospital Association (AHA) applauds this action and emphasizes the need for all payers to step up financially to ensure this disruption does not compromise continued patient care.

3. Optum’s Emergency Funding

Optum, a subsidiary of UnitedHealth Group, has established an emergency funding program to help providers in this hour of need. This program offers cost-free loans to affected providers. While the total funds available are not publicly known, and the loan amounts might not fully cover the provider’s expenses, they serve as a crucial resource, particularly for smaller practices. For more information and application details, visit the Optum website and process your loan.

4. Potential Support from Other Payers

Following HHS’s call to action, other private payers might also consider offering similar advance payment programs to their contracted providers. Stay updated with your payers’ communication channels for any announcements regarding financial assistance options.

Things to Remember:

• While these programs offer much-needed support, it’s crucial to gather all the necessary information before applying and checking your eligibility for the open programs. This may include details about your practice’s financial situation and documentation related to affected claims. The revenue cycle experts at Transcure can help you gather these detailed reports about your practice’s financial situation and help verify your eligibility.
• Explore all available options. Don’t limit yourself to a single program.
• Act promptly. The sooner you apply for assistance, the quicker you can receive the financial resources needed to maintain operations during this challenging time.

By leveraging these resources and remaining proactive in seeking financial support, healthcare providers can navigate the current disruption and continue delivering essential services to their patients.

What Other Ways Can You Choose to Recover Your Loss?

While Change Healthcare recovers from the cyberattack, here are some alternative ways to submit claims that might be impacted:

1. Direct Payer Submission:

• Contact each payer you submit claims to directly.
• Inquire about alternative submission methods they might be offering during this disruption. Some payers may accept claims through:

1. Their online portals (if available)
2. Secure email channels

2. Clearinghouse Alternatives:

• Consider using alternative clearinghouses to submit claims electronically.
• Research reputable clearinghouses that are not affiliated with Change Healthcare.
• Ensure the chosen clearinghouse has established connections with your payers for smooth claim routing.

3. Contact Your State Medicaid Agency:

• If you’re a Medicaid provider, contact your state Medicaid agency for guidance.
• They might have implemented alternative claim submission processes specifically for the Change Healthcare disruption.
• Explore alternative channels for submitting claims not yet processed by Change Healthcare.

Important Note:

• Before submitting claims through any alternative method, confirm the process with your specific payers to ensure they’re accepting submissions through that channel. Get help from professional billers like those at Transcure to get details about all USA payer policies.
• Keep detailed records of all communication with payers and any alternative claim submission attempts during this time. This documentation will be helpful if there are any issues with claim processing later.

Transcure’s Assistance – The Pro-Active Approach to the Recovery of Your Lost Cash Flow!

Approach result-driven medical billing companies in the USA like Transcure, which is one of the best among the rest. This is because billing companies can be crucial allies for providers navigating the financial challenges caused by the Change Healthcare cyberattack. Here’s how Transcure can offer significant support:

Immediate Relief

Assistance in Alternative Claim Submission:

• We can help identify and implement alternative claim submission methods for providers.
• Our certified 1100+ medical billers can assist with setting up online portals, secure email channels, or partnerships with alternative clearinghouses.

Advance Reconciliation:

Our medical billing company can begin preliminary reconciliation of claims even before Change Healthcare restores full functionality. This can help identify potential issues and expedite processing once the system is back online.

Long-Term Support

Cash Flow Management:

Our experts can help providers with short-term cash flow management strategies. This could involve analyzing historical data to forecast upcoming revenue and expenses. Additionally, we can assist with applications for financial relief programs offered by CMS, private payers, or Optum.

Coding and Documentation Review:

By ensuring accurate coding and complete documentation on claims, we can minimize denials and maximize reimbursements. This becomes even more critical during a time of potential delays like in the current cyber attack situation.

Negotiating with Payers:

Our experts can leverage their expertise to negotiate more favorable payment terms with payers. This could involve securing faster payment cycles or reducing administrative burdens.

Data Security and Risk Management:

Our professionals can offer guidance on data security best practices and risk mitigation strategies to help providers minimize the impact of future cyberattacks.

Proactive Follow-Up:

We can play a crucial role in following up with payers on behalf of providers to determine the status of stuck claims.

Transcure can act as a safety net for providers during this challenging time. By offering immediate relief through alternative claim submission and cash flow management and providing long-term support with coding and negotiation, we can help providers maintain financial stability and continue delivering essential care to patients.

Get Transcure’s Assistance to Revive Your AR After Change Healthcare System Restoration!

As Change Healthcare’s systems recover from the cyberattack, your top priority will be to reclaim your accounts receivable. Transcure’s AR experts are here to help you recover your stuck claims with our proven expertise. We’ll work tirelessly to recover your accounts and get you back on track financially.

Our comprehensive AR recovery services include:

• Denial Management: We’ll identify and appeal denied claims, maximizing your reimbursements.
• Coding and Documentation Review: We’ll ensure your claims are coded accurately and completely, minimizing denials and delays.
• Payer Negotiations: We’ll leverage our expertise to negotiate favorable payment terms with payers, expediting cash flow.
• Patient Collections: We’ll handle patient collections efficiently and respectfully, preserving your patient relationships.

With Transcure’s help, you can recover your AR quickly and efficiently, minimizing the financial impact of the Change Healthcare cyberattack.

To Sum It Up

In the end, the Change Healthcare cyberattack’s impact is undeniable, but you’re not alone. Relief programs from CMS, HHS, and your payers can help ease the financial burden. So, keep following the websites of government agencies and your payers to get updates and information about the recently announced relief programs. On the other hand, to keep your side double safe, explore alternative claim submission methods and consider partnering with a billing company like Transcure for additional support. Proactive action and available resources can help you recover and keep delivering essential care.

Don’t let this cyberattack cripple your healthcare practice. Contact Transcure today, and let us help you recover and move forward. Our experienced team will work closely with you to develop a customized plan to address your specific needs.

Frequently Asked Questions (FAQ’s)