HHS is supporting Medicare providers affected by the Change Healthcare hack
Federal officials on Tuesday unveiled a plan to help hospitals and health care providers unable to bill for their services after a cyberattack took down the nation's largest medical claims processor, following calls for federal intervention to address repercussions on patient care.
The Centers for Medicare and Medicaid Services (CMS) will encourage health insurers to eliminate or relax requirements that often slow billing, such as obtaining prior authorization before providing certain services to patients and other steps. The agency is also encouraging private health insurance companies to provide advances to organizations most affected by the cyberattack. CMS also said it would consider individual requests for expedited payments, such as those made during the coronavirus pandemic, recognizing that “hospitals are experiencing significant cash flow challenges due to the unusual circumstances impacting hospital operations could be.”
Senate Majority Leader Charles E. Schumer (D-N.Y.) had asked for such relief in a letter to federal officials on Friday and called the agency's action on Tuesday “an encouraging step.”
The Feb. 21 hack of Change Healthcare, part of UnitedHealth Group, crippled health care payments for tens of thousands of hospitals, doctors and other providers. Industry and government officials said it was one of the most serious cyberattacks ever carried out on the U.S. health care system. Federal officials, including HHS Secretary
Cash reserves are drying up at some hospitals and doctors' offices after being largely cut off from the ability to file medical claims and get paid by insurers for nearly two weeks. According to health care providers and industry representatives, in some cases patients are experiencing delays in care and are unable to take advantage of discount cards or patient assistance programs that run through the electronic clearinghouse operated by Change Healthcare.
It was not immediately clear whether the steps announced by federal officials Tuesday would adequately address the concerns of health care providers across the country. While UnitedHealth has provided emergency funding to affected organizations and is offering short-term loans through its Optum Health arm, doctors say the offerings are inadequate.
The cyberattack has gripped the healthcare industry and officials say it underscores the growing digital risks facing the healthcare system. “This incident is a reminder of the interconnectedness of the domestic healthcare ecosystem and the urgency to strengthen cybersecurity resilience,” HHS said in its statement.
The hackers stole patient data, encrypted company files and demanded money to unlock them. Change Healthcare then shut down most of its network to perform a recovery. UnitedHealth declined to comment reports that ransomware gang ALPHV has received a $22 million payment. “We are focused on the investigation,” the company said in a statement on Monday.
Change Healthcare processes 15 billion medical claims annually, far more than any other company, and is a critical pipeline that connects healthcare organizations with insurance companies that evaluate their claims, pay for their services and determine the cost of patient care.
CMS has directed providers to contact their Medicare administrative contractors to enroll in a new electronic clearinghouse to process claims and has directed contractors to expedite the onboarding and billing process, the agency said Tuesday. Many organizations have used the simple electronic platform of Availity, a competitor to Change Healthcare that also operates a large medical claims clearinghouse.
Availity said claims volume has increased by up to 70 percent since the Change outage as the company works through the resulting backlog the cyber attack. The company has connected more than 300,000 providers through this platform, which the company says it offers free of charge.
“We’re building really strong relationships with people in need,” Availity CEO Russ Thomas said in an interview. But he's particularly concerned about smaller healthcare operations and says the current outage could be even more devastating than the coronavirus.
“As a doctor, you have to take care of your patients. They just can’t charge for it right now,” Thomas said.
The measures announced by HHS fall short of what some had hoped for.
Christine Meyer, the owner of a primary care practice outside of Philadelphia that serves 20,000 patients, is seeing her payments from insurance companies drop by the day. Her practice normally receives deposits between $20,000 and $70,000 per day, but on Tuesday she received just $1,600, which Meyer said was the lowest in 20 years.
“I'm afraid our money won't last much longer,” said Meyer, adding that she applied for a loan to buy time.
Switching to a platform like Availity's free service isn't an option, she said, because it requires an electronic file of patient claims information that her software provider can't generate. So their employees manually enter claims into the electronic portals of insurance companies that offer it, while simultaneously submitting paper claims to Medicare.
Meyer said she has managed to avoid impacts on patient care so far, but she fears she may have to send doctors home if her money continues to shrink.
“For this to happen in the blink of an eye and without warning, for me to struggle to get money together, is ridiculous,” Meyer said. In response to the HHS plan, she said, “Unfortunately, it does not provide immediate relief for providers other than hospitals. “Hopefully that will change.”
HHS said Tuesday that payers — such as insurance companies — are granting funds to providers whose billing systems have been taken offline and urged them to take advantage of such offers. However, many have scoffed at the temporary support offered by Optum, a health services company also owned by UnitedHealth.
AnneMarie Walker-Czyz, CEO of Rome Health, said its system in central New York has been unable to process 3,200 claims totaling $13.4 million since the Feb. 21 hack and is suffering a loss of $2.3 million per week. Optum offered $11,700 a week to be paid back, she said, calling it “a lot of work for very little return given our current crippling circumstances.”
Walker-Czyz's staff tries to file claims manually, she said. “It’s like going back to the Stone Age in healthcare and hand-typing everything we do,” she said.
UnitedHealth did not immediately respond to a request seeking comment on the criticism.
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