Editor’s note: Testing of Change Healthcare’s claims systems is set to start March 18. “The prospect of a month or more without a restored Change Healthcare claims system emphasizes the critical need for economic assistance to physicians, including advancing funds to financially stressed medical practices,” Dr. Ehrenfeld said in a March 8 statement.
And in a new letter to CMS, the AMA asked the agency to automatically apply the Extreme and Uncontrollable Circumstances hardship exception (PDF) for the 2023 performance period to all physicians eligible for the Merit-based Incentive Payment System (MIPS).
The Department of Health and Human Services (HHS) is responding to pleas from the AMA and others for regulatory flexibility to help ease the major disruptions in claims processing and payment linked to the cyber outage at UnitedHealth Group subsidiary Change Healthcare. While the AMA appreciates the flexibilities that HHS and the Centers for Medicare & Medicaid Services (CMS) announced, the administration needs to go further to provide relief for physicians.
“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,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “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.”
The cybersecurity-linked outage is costing the health care industry an estimated $100 million a day.
“The American Medical Association credits the Department of Health and Human Services and the Centers for Medicare & Medicaid Services for responding to the urgent situation caused by the Change Healthcare cybersecurity incident and the unprecedented disruptions to medical practices and access to care,” Dr. Ehrenfeld added.
In a statement issued March 5, HHS announced that the Centers for Medicare & Medicaid Services (CMS) will:
- Issue guidance to Medicare Advantage organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging Medicare Advantage plans to offer advance funding to providers most affected by this cyberattack.
- Strongly encourage Medicaid and Children’s Health Insurance Plan (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.
According to HHS, CMS has already contacted all Medicare administrative contractors (MACs) and said that physicians and other Medicare providers needing to change the clearinghouse they use for claims processing during the outage should contact their MAC to request a new a new electronic data interchange enrollment for the switch.
In addition, HHS said that the MACs will provide instructions based on the specific request to expedite the new enrollment and CMS has instructed the MACs to expedite this process and move all provider and facility requests into production to enable quick claims billing capability. The agency is strongly encouraging other payers, including state Medicaid and CHIP agencies and Medicaid and CHIP managed-care plans, to waive or expedite solutions for this requirement.
HHS must provide more information so that physicians can navigate the challenges and keep their practices open to care for patients. The AMA will continue to press the administration to secure relief for physicians.
The administration’s moves, which follow a March 1 AMA letter to HHS Secretary Xavier Becerra, “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,” Dr. Ehrenfeld said.
Change Healthcare started experiencing major problems Feb. 21. The AMA has assembled a resource page on the Change Healthcare cyber outage and steps that physicians can take.
