The Centers for Medicare & Medicaid Services (CMS) will consider advance payments to Part B suppliers experiencing disruption in claims payments after a cyberattack on Change Healthcare in late February.
CMS announced the plan to accelerate payments on March 9.
On its website, Change Healthcare, part of UnitedHealth Group, said it discovered the cyberattack on Feb. 21 and disconnected its systems “to prevent further impact.”
Change Healthcare described itself as working “across the health system to make clinical, administrative and financial processes simpler and more efficient for payers, providers and consumers. Key areas of support include pharmacy claims transactions, provider claims processing, patient access and financial clearance, provider payments, and authorizations and medical necessity reviews.”
Cyberattack impacts cash flow to health-care providers
“Numerous hospitals, doctors, pharmacies and other stakeholders have highlighted potential cash flow concerns to HHS stemming from an inability to submit claims and receive payments,” the Department of Health & Human Services (HHS) acknowledged in a March 5 statement.
The statement from CMS on March 9 said the agency is “in frequent communication with UnitedHealth Group and Change/Optum and will continue to press them to swiftly communicate with the health-care sector and to offer better options for interim payments to providers and suppliers to ensure continuity of operations for all health-care providers and suppliers impacted by the incident.”
But the attack, CMS added, could mean providers and suppliers “may face significant cash-flow problems from the unusual circumstances impacting facilities’ operations, preventing facilities from submitting claims and receiving Medicare claims payments when using the Change Healthcare platform.”
In its March 9 bulletin, CMS said Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments “may be granted in amounts representative of up to 30 days of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider/supplier 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.”
CMS lists eligibility requirements
In a March 11 bulletin to members and stakeholders, the American Association for Homecare (AAHomecare) noted eligibility requirements for the accelerated and advance payments, including that the payments must be requested for individual providers and suppliers with “unique National Provider identifier and Medicare ID combinations.”
AAHomecare said providers and suppliers applying for these payments must have experienced disruptions in claims payments or submissions “due to a business relationship [with] the provider/supplier, or the provider’s supplier’s third-party payers, has with Change Healthcare or another entity that uses Change Healthcare or requires the provider/supplier to use Change Healthcare.”
CMS’s Fact Sheet added that the provider or supplier must be “unable to obtain sufficient funding from other available sources to cover the disruption in claims payment, processing, or submission attributable to the incident.”
AAHomecare said the DME MACs have been updating their Change Healthcare security incident pages accordingly.
“AAHomecare will share additional information from CMS and the MACs as it becomes available and continue to update our online resources related to the disruption,” the association added.