Post Change Cyberattack, CMS Offers Provider Flexibilities


The CMS in the US has gone on to roll out numerous flexibilities on March 5 that look forward to helping the mounting financial challenges of providers in the wake of the cyberattack against Change Healthcare.
The agency has gone on to instruct Medicare administrative contractors, who go ahead and process claims for the government, to speed up provider requests so as to switch to novel clearinghouses and get around the Change outage. CMS happens to be also encouraging Medicare Advantage plans, Part D sponsors, as well as Medicaid and Children’s Health Insurance Program managed care plans to kind of relax the prior authorization needs or offer advanced funding.

As per the agency, the providers can go ahead and submit requests for fast payment as far as their Medicare administrative contractors are concerned when it comes to their individual consideration.

The fact is that the outage at Change has gone on to disrupt the healthcare sector for almost two weeks.

Providers have gone on to report quite significant challenges to their day-to-day functioning, which also include problems in terms of receiving payment from patients as well as insurers, verifying the coverage, submitting authorization requests in advance, or for that even exchanging clinical data.

Groups such as the American Hospital Association, the American Medical Association, as well as the Medical Group Management Association have gone on to urge the federal government to take measures so as to mitigate the damage that has been caused due to the cyberattack, which they say could as well lead to devastating financial effects for smaller practices.

Although the flexibilities from the CMS are indeed a welcome first step, Jesse Ehrenfeld, the AMA President, went on to argue that regulators should go further so as to bolster physician practices throughout the outage, which could even last weeks, as per the reporting done by Stat News.

He added that there are many physicians who operate on quite thin margins, and one is especially concerned when it comes to the impact on small as well as rural practices, and also concerning those that care for the underserved. The AMA has gone on to urge federal officials to go above and beyond what has already been put in place and, at the same time, also include financial assistance like advanced payments for physicians.

Rick Pollack, who happens to be the AHA President and CEO, said the Change cyberattack happens to be the most significant and consequential event of its kind against the U.S. healthcare sector in its history, and he has also called on the executive branch to make sure to take action if the federal agencies happen to be limited.

The enormity of this moment goes on to deserve the same level of urgency as the leadership the government has rolled out for any national event of this magnitude prior to this. The steps that have been announced do not do that, and they are not an adequate government response.”

It is well to be noted that the cyberattack at Change, which was acquired by the Optum segment of the insurer UnitedHealth Group in 2022, comes since cybersecurity has become quite a progressive challenge for the healthcare sector. The HHS, in a statement, said that the outage was a reminder of interconnectedness when it comes to the healthcare ecosystem, and has pushed the sector to double down when it comes to cybersecurity as well as resilience.

The CMS went on to say that it has also gone on to contact the Medicare administrative contractors so as to ensure that they can accept paper claims and has also told providers that they should contact their contractors when it comes to details on exceptions, waivers, or even extensions if they have any kind of trouble filing the claims. They can as well contact the agency with regards to the quality reporting programs.