CMS offers flexibilities in wake of Change Healthcare cyberattack

The Centers for Medicaid & Medicare Services (CMS) are offering flexibilities in response to the Change Healthcare Cyberattack that has paralyzed healthcare organizations’ ability to perform essential functions like submitting claims and processing prescriptions since February 21. 

Among other benefits, the flexibilities intend to help expedite the process of Medicare Administrative Contractors (MACs) switching to new electronic data interchanges (EDIs) so they can resume operations as soon as possible without waiting on the outcomes of Change Healthcare. CMS proposes these flexibilities for the duration of the outage. 

CMS flexibilities in wake of Change Healthcare outage:

• • Expedited switch to new clearinghouse: Medicare providers looking to switch clearinghouses during the outage should contact their MAC for a new electronic data interchange (EDI) enrollment. CMS has directed MACs to expedite these claims and urges other payers, like Medicaid and Children’s Health Insurance Program (CHIP) to do the same.
  • Advance funding to healthcare providers: CMS is urging Medicare Advantage plans to provide funding in advance to providers impacted by the outage. CMS is also prompting Medicaid and CHIP managed care plans to “strongly consider” offering similar funding options to providers on behalf of their enrollees.
  • Easing of admin requirements: CMS plans to issue guidance to MA organizations and Part D sponsors urging them to waive or ease prior authorization, utilization management, and other filing requirements during the outage. CMS is also advocating for Medicaid and CHIP managed care plans to do the same. 
  • Return to paper claims: MACs must be prepared to accept paper claims.

In addition to the new flexibilities, CMS requests that if Medicare providers run into trouble filing claims, they should contact their MAC for information on exceptions and waivers, or contact CMS for information on quality reporting programs. 

“We cannot say this more clearly – the Change Healthcare cyberattack is the most significant and consequential incident of its kind against the U.S. health care system in history,” said AHA President and CEO Rick Pollack in a statement to the media. “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 health care services they provide.”

Change Healthcare’s now 15-day outage has resulted in a dangerous dip in revenue for healthcare organizations that are struggling for temporary  financial assistance in order to make sure they can pay their staff and order essential supplies. 

While UnitedHealth Group opened a Temporary Financial Assistance program for healthcare providers who qualify, Pollack insists it is not enough to ensure the nation’s healthcare organizations survive. 

“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.

“Rest assured, the AHA will continue to work with Congress on meaningful solutions to preserve 24/7 access to care. If limitations exist for an appropriate government response, it is incumbent upon the executive branch to propose the necessary legislation and authorities to ensure the provider network in this nation is not further compromised.”