CMS Announces Terms of Accelerated and Advanced Payments
CMS issued a fact sheet on how its new Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance payments will be evaluated and shared this information with the Medicare Administrative Contractors (MACs) on March 8. It does note that both Part A and B providers are eligible but must certify that they meet several criteria. CMS makes it clear not all providers will receive funds through CHOPD, but it will follow the normal recoupment policies where CMS automatically recoups funds to offset the advance payments as provider’s submit Medicare claims. This occurs over 90 days with any remaining balance being collected on day 91. Providers will be eligible for an amount equal to their 30-day claims average and will be based on data from August 1 – October 31, 2023.
On March 9, CMS followed up with a letter to health care leaders outlining their expectations of UnitedHealth Group (UHG) and other insurers in response to the Change Healthcare cyberattack. The focus of these remarks was about UHG and other insurers helping impacted providers with interim funding and prioritizing those who are “under-resourced, and lower-margin providers.” CMS stressed that UHG “take responsibility to ensure no provider is compromised by their cash flow challenges…” Additionally, CMS urged all insurers to pause prior authorizations and other utilization management requirements, accept paper claims, and to “stop-gap” the cash flow concerns of providers with bridge payments.
United Health Projects Back Online the Week of March 18
UnitedHealth Group updated providers on available programs and the status of its Change Healthcare products on March 8. Its electronic payment platform is expected to be restored by March 15. The week of March 18 it will begin testing its medical claims network and note they expect it to be fully operational sometime that week. In the interim, providers are strongly encouraged to continue to use their iEDI claim submission system and alternative clearinghouse until there is confirmation that the Change Healthcare systems are again fully functional. UHG also announced it was expanding eligibility for its Temporary Funding Assistance Program (TFAP) to providers who have “exhausted all available connection options and who work with a payer that has opted not to advance funds while the CHC systems remain down.” This implies that they, too, are a payer of last resort like CMS has said for its CHOPD funding. LeadingAge is seeking clarity about which program is the actual payer of last resort. UHG also extended its timeframe for providers to repay these funds to 30 days from receipt of an invoice from UHG and these invoices will be sent once “standard payment operations resume.” LeadingAge will be expressing its concern about this short timeline and on other key issues to HHS at a March 12 meeting. Finally, UHG says it is suspending prior authorizations for outpatient services and pausing utilization review for inpatient admissions but there is no clarity on whether these temporary changes will have any impact on skilled nursing facilities, home health agencies or hospice providers. Providers are encouraged to check with their payers to see what flexibility they may be deploying related to prior authorizations, timely filings, and other utilization management items.
