The AAP continues to advocate for measures that would provide relief to pediatric practices that have been impacted by the cyberattack on Change Healthcare and pediatricians can apply for temporary funding assistance.
The AAP and other health care organizations met with federal officials Tuesday to discuss the need for more immediate payment options and relaxed billing and claims processing requirements.
“We are working with the federal government to make sure payers take every action possible to support pediatric practices until all claims are processed and paid,” said AAP CEO/Executive Vice President Mark Del Monte, J.D., who took part in the meeting.
Impact of the cyberattack
Change Healthcare, which is owned by UnitedHealth Group, processes 15 billion health care transactions each year. On Feb. 21, it began responding to a cybersecurity issue, taking some systems offline and establishing workarounds.
The attack has impacted pharmacies, claims and payments. It caused delays in verifying patient insurance coverage, prior authorizations, some care coordination and patient billing. It has been especially significant for primary care practices, which often operate on thin financial margins.
Seth D. Kaplan, M.D., FAAP, vice president of the Texas Pediatric Society, owns a two-doctor practice in Frisco. He has about $6,000 in Aetna claims in limbo, which he said “has a fair amount of impact” for a small practice like his. He is grateful it is only affecting his claims from one company, but still is feeling the squeeze.
“Thankfully …. we had some reserves that we’ve been relying on,” he said. “But if this thing does not get turned around soon, it’s going to affect our ability to make payroll.”
Temporary funding assistance, service restoration
The AAP has met with leaders of UnitedHealth Group to express its concerns about the service outage. UnitedHealth has launched a temporary funding assistance program for providers through its subsidiary, Optum. Eligible providers can complete one-time registration to access funding with no associated fees or interest. Advances will not need to be repaid until the claims system is restored. After that time, they will have 30 days to return the funds.
Dr. Kaplan said he has received one such payment but “it doesn’t come near the usual volume we do with Aetna.” He is unsure if there is a lag in processing and whether more assistance is coming. In a March 10 letter, the Department of Health and Human Services (HHS) called on UnitedHealth Group to ensure expedited delivery of funds.
As of March 8, UnitedHealth said its electronic prescribing was fully functional with claim submission and the Change Healthcare Pharmacy Network was back online. The company expects to have electronic payment functionality available for connection starting March 15 followed by re-establishing connectivity to its claims network and software March 18. Service will be restored throughout that week.
“All of us at UnitedHealth Group feel a deep sense of responsibility for recovery and are working tirelessly to ensure that providers can care for their patients and run their practices, and that patients can get their medications,” CEO Andrew Witty said in a statement. “We’re determined to make this right as fast as possible.”
Federal and state action
Following advocacy from the AAP, the Centers for Disease Control and Prevention (CDC) on Wednesday urged Vaccines for Children program awardees to consider flexibilities related to borrowing and private stock requirements. The AAP also has asked vaccine manufacturers for extended invoice payment terms for vaccine purchases.
In addition to working with UnitedHealth Group, HHS is urging insurance companies and other payers to make interim payments to impacted providers and pause the requirement for prior authorizations.
The Centers for Medicare & Medicaid Services (CMS) is considering applications for accelerated payments for Medicare Part A providers and applications for advance payments for Part B practitioners and suppliers. It also has streamlined the process for providers to change clearinghouses to ensure continuity of payments, encouraged insurance plans to remove or relax prior authorizations in Medicare and Medicaid and directed Medicare administrative contractors to be prepared to accept paper claims submissions during the outage.
CMS also is working on guidance for states to support Medicaid providers and urging Medicaid managed care plans to make prospective payments to impacted providers.
Additional support varies by state. Some are providing information on alternate clearinghouses and encouraging insurance plan flexibility. Some state Medicaid agencies have authorized pharmacies to dispense up to 30 days of medication and waived cost sharing and other pharmacy requirements. AAP chapters interested in working on this issue in their states are encouraged to contact AAP State Advocacy for targeted assistance.
The American Medical Association (AMA) also has been advocating for more support for physicians. In a March 11 letter to HHS, it asked for an inventory of health plans offering advance payments, assurance that Medicare administrative contractors and health plans are accepting paper claims, support for physicians requesting expedited electronic data interchange enrollment to switch claims processing clearinghouses, hardship exemptions for CMS-impacted programs, waivers of timely filing deadlines for claims and appeals and postponement of health information technology community user fees.
The AMA urged an “all hands on deck” approach “using all regulatory flexibilities to continue supporting physicians and tackle this enormous interruption in day-to-day physician practice operations that has impeded physicians’ ability to care for patients.”
Resources
- Updates on the cyberattack from UnitedHealth Group
- Temporary funding assistance program for providers
- Information on the outage from the American Medical Association
- Information from CMS on accelerated payments to Medicare Part A providers and advance payments to Part B suppliers
- HHS Healthcare and Public Health Cybersecurity Performance Goals
- AAP Webinar: Keeping Pediatric PHI Secure: Using the Security Risk Assessment Tool
- Security Risk Assessment Tool
- Top 10 Myths of Security Risk Analysis
- Health IT Privacy and Security Resources for Providers
- Privacy & Security Resources for Patients
