The Centers for Medicare and Medicaid Services has rolled out efforts to help providers navigate the Change Healthcare outage disrupting healthcare operations nationwide, the Health and Human Services Department announced Tuesday.
CMS ordered its claims administrators to assist pharmacies, hospitals and others that need to use alternate means to process transactions while Change Healthcare, part of UnitedHealth Group's Optum subsidiary, works to get its systems back online following a Feb. 21 cyberattack. The agency also offered assistance to address the financial squeeze some providers are enduring.
Related: Change Healthcare outage: AHA slams UnitedHealth funding program
The Change Healthcare outage has challenged pharmacies, hospitals, physician offices, nursing homes and patients for nearly two weeks. UnitedHealth Group blames the ransomware group known as BlackCat (also called ALPHV or Noberus) for the breach.
UnitedHealth Group expects the Change Healthcare pharmacy network to be operational again for the "vast majority" of customers as soon as Thursday, the company said in a notice published on its website Tuesday.
"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," HHS said in a news release. "HHS has heard these concerns and is taking direct action and working to support the important needs of the healthcare community."
The American Hospital Association, the American Medical Association and the American Health Care Association/National Center for Assisted Living had asked HHS Secretary Xavier Becerra to provide accelerated Medicare reimbursements. Senate Majority Leader Chuck Schumer (D-N.Y.) made the same request in a letter sent to CMS Administrator Chiquita Brooks-LaSure on Friday.
Although HHS did not promise advanced payments across the board, it encouraged providers to request them from CMS' Medicare administrative contractors, which will conduct "individual consideration" of such submissions.
"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," AMA President Dr. Jesse Ehrenfeld said in a news release.
The AHA expressed dissatisfaction with CMS' plan. "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. The measures announced today do not do that and are not an adequate whole of government response," AHA President and CEO Rick Pollack said in a news release.
“We appreciate the efforts by the U.S. Department of Health and Human Services," an AHCA/NCAL spokesperson wrote in an email. "Providers will continue to take advantage of these workarounds, but we hope for a swift resolution to this issue.”
HHS also advised providers to seek relief from private health insurance companies. "We understand that many payers are making funds available while billing systems are offline, and providers should take advantage of those opportunities," HHS said in the news release.
The CMS plan
CMS requested that Medicare Advantage and Part D insurers relax or waive utilization management rules such as prior authorization during the outage, and will provide guidance to companies on how to implement those flexibilities. CMS encouraged insurers that cover Medicaid and Children's Health Insurance Program beneficiaries to do the same.
Medicare administrative contractors—companies such as Noridian Healthcare Solutions and Novitas Solutions that process claims for the government—are the primary points of contact for providers needing help during the Change Healthcare outage.
Providers that need to enroll in alternate electronic data interchanges to get around Change Healthcare's systems should turn to their regional CMS contractors, HHS said in the news release. CMS is "strongly encouraging" state Medicaid and CHIP programs, and the insurance companies that participate in them, to offer similar assistance, HHS said.
The contractors also are responsible for helping providers that need to use paper claims and advising providers on how the current situation may affect quality reporting and rating programs.
More help from UnitedHealth Group
UnitedHealth Group set up a temporary version of its Rx ePrescribing service and offered interest-free loans to providers Friday. The AHA criticized the lending program for its limited eligibility criteria and contract terms and conditions it deems unfair.
On Tuesday, UnitedHealth Group said it would announce a supplemental financial assistance program on Friday for providers unable to submit claims through an Optum electronic data interchange that more than 25 payers so far are using while the Change Healthcare interchange is unavailable. The company said it will contact eligible providers to notify them about the option.
HHS continues to monitor UnitedHealth Group's response to the cyberattack and is collaborating with other federal entities such as the FBI and Cybersecurity and Infrastructure Security Agency to investigate the crime, assess its impact and gather information to anticipate future breaches, the news release said.
"HHS also takes this opportunity to encourage all providers, technology vendors and members of the healthcare ecosystem to double down on cybersecurity, with urgency. The system and the American people can ill afford further disruptions in care," the department said in the news release.
