CMS to advance pay to doctors affected by disruptive cyberattack

Kevin B. O'Reilly , Senior News Editor

The Centers for Medicare & Medicaid Services (CMS) today announced a program of accelerated payments to Medicare Part A providers and advance payments to Part B providers to help stem the immense financial fallout of the February cyberattack on the claims-processing systems of Change Healthcare, a subisidiary of UnitedHealth Group.

The move comes in the wake of forceful advocacy from the AMA calling for additional relief for physicians given the estimated $100 million daily impact of the outage on the health care industry.

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As AMA President Jesse M. Ehrenfeld, MD, MPH, noted in a statement earlier this week, “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.”

That is why the AMA urged “federal officials to go above and beyond” earlier regulatory flexibilities that had been put in place to “include financial assistance” for doctors. With testing of the Change Healthcare claims-processing system not set to start until March 18, Dr. Ehrenfeld noted yesterday that “the prospect of a month or more without a restored Change Healthcare claims system emphasizes the critical need for economic assistance to physicians.”

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.

Payments based on 2023 claims period

In a fact sheet on the newly introduced program—called Change Healthcare/Optum Payment Disruption (CHOPD)—CMS said that physicians and other Medicare providers experiencing disruption because of the Change Healthcare outage can apply for “amounts representative of up to 30 days of claims payments.”

That 30-pay payment will be based on the monthly average of the total claims paid to the physician between Aug. 1–Oct. 31, 2023. The repayment terms, which some physician practices may find challenging, require that physicians and others taking part in the program repay CMS through “automatic recoupment from Medicare claims” over 90 days. The agency notes that “a demand will be issued for any remaining balance on day 91 following the issuance of the accelerated or advance payment.”

Physicians and others applying for the advance or accelerated payments must make 13 separate certifications, covering, for example, that the doctor “has been unable to obtain sufficient funding from other available sources to cover the disruption in claims payment, processing or submission attributable to the incident.”

They also must acknowledge at least eight separate terms of the payments, including that “repayment will commence immediately via 100% recoupment of Medicare claims payments owed to the provider/supplier, as the provider/supplier submits claims and claims are processed, after the date on which the payment is granted. Recoupment will continue for a period of 90 days.”

To apply for accelerated and advance payments, physicians should work with their local Medicare administrative contractor.

In a CMS statement also issued today, the agency said it “is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types." 

The CMS statement adds that the agency “recognizes that many Medicaid providers are deeply affected by the impact of the cyberattack. We are continuing to work closely with states and are urging Medicaid managed care plans to make prospective payments to impacted providers, as well.”