Federal officials have announced several flexibilities that aim to help physicians in the wake of the cyberattack against Change Healthcare, which upset payment and revenue cycle management operations for practices across the country.
On the morning of Saturday, March 9, the Centers for Medicare & Medicaid Services (CMS) announced an accelerated avenue of assistance for physicians and practices impacted by the attack. Practices may now request advanced Medicare payments in order to sustain practice operations during this disruption.
Details on this program can be found in this CMS fact sheet and in this statement.
Also of this writing, Change Healthcare had anticipated that electronic payment functionality via its payment platform would be available for connection beginning March 15. The company’s website also said it expected “to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.”
Earlier in the week, CMS had instructed Medicare Administrative Contractors (MACs) to accept paper claims from physicians who need to use them, and to expedite physician requests to switch to new clearinghouses to work around the Change Healthcare outage.
“While we recognize that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method,” HHS stated.
Texas’ MAC, Novitas, recently shared instructions with Texas Medical Association experts on how physicians can send paper claims and work around ongoing issues related to the cyberattack. According to Novitas:
- Paper claims processing requires a minimum 29-day payment floor, which means payment cannot be released before the 29th day following receipt.
- There is no automated editing for claim errors as there is with electronic billing, so if a paper claim form contains mistakes, the Medicare contractor will have to return the claim to the physician to make corrections for resubmission.
- For electronic submissions, physicians can submit their claims through Direct Data Entry or elect to change their network service vendor.
- Novitas is expediting requests from health care professionals impacted by the Change Healthcare issue as they come in. Physicians can also enroll in Novitas’ portal, Novitasphere, which the contractor says allows for claim submission and remittance retrieval.
The contractor also stated that due to Administrative Simplification Compliance Act (ASCA) requirements, Medicare system settings for electronic-only billers need to be manually updated to allow for paper submission.
CMS has approved a waiver of those requirements for those impacted by the Change Healthcare cyberattack. To request the waiver, physicians can complete the ASCA Waiver Request form.
CMS said it will issue guidance encouraging Medicare Advantage (MA) plans and Part D sponsors to remove or relax prior authorization, other utilization management, and timely filing requirements. CMS is also encouraging MA plans to offer advance funding to health care professionals most affected by the cyberattack. Additionally, CMS is strongly encouraging Medicaid and Children’s Health Insurance Program managed care plans to adopt similar strategies. Physicians can submit requests for accelerated payment to their MAC for individual consideration.
These developments followed a March 1 letter to federal officials in which the American Medical Association (AMA) urged the federal government to take additional steps to alleviate the damage caused by the cyberattack, warning it could severely hamper physicians’ ability to care for patients.
“Given the combined financial impact of the Change Healthcare hack and Medicare payment cuts to physicians, the AMA urged HHS ‘to utilize any available emergency funds and authorities to provide critical financial resources to physicians, ensuring they can continue to deliver essential health care services during these challenging times,’” as well as facilitate expedited and direct communications with physician practices, AMA said in a statement.
As of this writing, Change Healthcare had anticipated that electronic payment functionality via its payment platform would be available for connection beginning March 15. The company’s website also said it expected “to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.”
Physicians may continue to see disruptions in claims processing, eligibility checks, or day-to-day practice operations due to ongoing system outages. TMA experts recommend practices communicate with private health plans, as well, to ensure they are accepting paper claims, and if not, refer them to HHS guidance to make sure they are aware of CMS’ flexibilities.
The Texas Department of Insurance and UnitedHealth Group – which owns Change Healthcare through its Optum subsidiary – have offered claims and payment flexibilities as well.
Concerned practices should conduct their own risk evaluations and if necessary, take steps to protect their network, which may include coordinating with their electronic health record vendors to determine whether they should shut down their exposure to Optum if they are using the Change Healthcare clearinghouse. Additionally, practices should continue to evaluate updates from the company.
TMA experts also recommend physicians avoid delays in claims payment by using alternative means of submission when appropriate. Practices are encouraged to check with health plans to see if they can submit claims via a physician’s portal.
TMA is monitoring updates on the attack as it rapidly evolves. Continue to read Texas Medicine Today for the latest.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469