HHS response to cash flow concerns from Change cyberattack inadequate, providers say

Photo: Courtesy UnitedHealth Group

The Department of Health and Human Services is offering flexibilities to hospitals, physicians, pharmacies and other stakeholders to help ease cash flow concerns caused by the Change Healthcare cyberattack and resulting disruption of services.

Provider payment has been affected by an inability to submit claims. 

While providers said they appreciate the flexibilities offered by the Centers for Medicare and Medicaid Services, what's being offered doesn't go far enough.

"The magnitude of this moment deserves the same level of urgency and leadership our government has deployed to any national event of this scale before it," said Rick Pollack, president and CEO of the American Hospital Association. "The measures announced today do not do that and are not an adequate whole of government response."

In a post aimed at easing concerns, UnitedHealth Group on Tuesday gave updates on resolving pharmacy and claims issues. Its pharmacy network could be back online as soon as today, UHG said.

WHY THIS MATTERS: UHG UPDATES

"As workarounds continue to be deployed, our latest data shows 90% of claims are flowing uninterrupted. Fast adoption and implementation of additional solutions by payers and providers could increase claims to 95% sometime next week," UHG said on its Change response update page. 

e-Prescribe is available for pharmacies to receive electronic payments, UHG said.

"As a result of workarounds and systems coming back online, we continue to see pharmacy claims flowing at near-normal levels," UHG said. "While some pharmacies are still unable to submit claims, we are making progress toward full restoration.   

"The pharmacy network, which connects pharmacies and PBMs, is in final end-to-end testing with our partners. We anticipate that our Change Healthcare Pharmacy network will be back online for the vast majority of submitters as soon as Thursday. This will allow pharmacies to submit real-time claims and receive payments on those claims.

"We believe full recovery of the medical network will take longer than the pharmacy network. We are encouraging payers and providers experiencing challenges to use the available temporary solutions to get claims flowing again."

Optum Financial Services established a temporary funding assistance program at www.optum.com/temporaryfunding to help with short-term cash flow needs for providers who receive payments from payers that were processed by Change Healthcare. When normal payment operations resume, the funds would need to be repaid at no interest, with no fees or other associated costs.

Aledade said it is offering accelerated payment of up to $100 million in shared savings to partner practices experiencing financial hardship.

WHAT CMS IS OFFERING

CMS said it has heard from providers about the availability of accelerated payments, like those issued during the COVID-19 pandemic. 

"We understand that many payers are making funds available while billing systems are offline, and providers should take advantage of those opportunities," CMS said.

Facilities may submit accelerated payment requests to their Medicare Administrative Contractors. Specific information will be available from the MACs later this week, CMS said.

Medicare providers needing to change clearinghouses that they use for claims processing should contact their MAC to request a new electronic data interchange (EDI) enrollment for the switch. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. 

CMS said it 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 is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.

CMS is also strongly encouraging 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 the 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 of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. 

PROVIDER REACTION

"We cannot say this more clearly – the Change Healthcare cyberattack is the most significant and consequential incident of its kind against the U.S. healthcare system in history," said AHA President and CEO Rick Pollack. "For nearly two weeks, this attack has made it harder for hospitals to provide patient care, fill prescriptions, submit insurance claims and receive payment for the essential healthcare services they provide."

Dr. Jesse M. Ehrenfeld, president of the American Medical Association said: "The newly announced flexibilities that have been put in place are a welcome first step, but we urge CMS to recognize that physicians are experiencing financial struggles that threaten the viability of many medical practices. Many physician practices operate on thin margins, and we are especially concerned about the impact on small and/or rural practices, as well as those that care for the underserved. The AMA urges federal officials to go above and beyond what has been put in place and include financial assistance such as advanced payments for physicians."
 
MGMA's SVP of Government Affairs Anders Gilberg said: "These actions being taken by CMS will begin to provide our nation's physician practices with a reprieve from the cascading administrative burdens currently threatening their viability and patient access to care. Physician practices are in no way immune to the significant cash flow problems resulting from this incident and are often far more vulnerable than hospitals able to carry larger financial reserves. CMS must require its contractors to extend the availability of accelerated payments to physician practices in a similar manner to which they are being offered to hospitals."

THE LARGER TREND

UHG has not confirmed that it paid $22 million in ransomware, as reported by Reuters.

"We are focused on the investigation and restoring operations at Change," UHG said by statement.  

Change Healthcare, which combined with UHG subsidiary Optum in 2022, discovered the cyberattack on Feb. 21 and disconnected its systems. Change handles payment processes for healthcare providers and payers.

ON THE RECORD

"This incident is a reminder of the interconnectedness of the domestic healthcare ecosystem and of the urgency of strengthening cybersecurity resiliency across the ecosystem," HHS said.

Email the writer: SMorse@himss.org

 
."