Feds Pressuring Payers to Increase Assistance Efforts After Change Attack

U.S. officials are putting the pressure on payers to take more targeted action.

This week payers met with federal officials to discuss how they can advance timely payments to providers who are still struggling after the massive cyberattack on Change Healthcare.

Payers were asked to prepare details on how they plan to financially support providers, how they are working to meet the challenges, and recovery efforts that still need to be made.

Payers are concerned about how their money will be recuperated in the future, according to a report from Bloomberg.

HHS has urged payers since the beginning of the attack to help providers by removing or relaxing prior authorizations, but the pushback has been strong. AHIP President and CEO Mike Tuffin issued a statement on March 12 about insurers responding to the attack.

Since the impact varies across their system, United urged individual plans and providers to sort out payments in a timely manner, as they’re in the best position to do so.

“Further, broad exemptions in prior authorization at a time of advanced payments could expose patients and employers to fraud, waste and unnecessary costs,”  said Tuffin.

UnitedHealth

UnitedHealth has recently made more moves to help their providers, from new software to advancing payments.  

In a press release, the organization announced it will be launching software for preparation of medical claims and announced that it has advanced $2B to providers who are still struggling after the attack. The software will be made available to thousands of customers over the next several days and it expects to have third-party attestations available before these services become operational. After this initial phase, other restoration services will continue until all its customers have been connected.

UnitedHealth has also been reported as offering substantial loans to some providers after the cyberattack. Stat News reported that this change comes as hospitals, doctors and lobbying groups have complained for weeks about United’s low offers, some less than 1% of their regular weekly billing. Now, some providers have seen their advances increase up to seven figures, but we’re not sure why or what prompted these specific loans.

But What About The Other Payers?

UnitedHealth seems to be making headway on helping their providers, but what about other payers? During the March 18 meeting, several payers said they would commit to advancing payments to providers, but these payers were not named.

According to Reuters an unidentified U.S. official said, "Claims are starting to flow and we have seen significant improvement between last week and this week, but we have a last mile to go.”

In a press release HHS said that it surveyed payers in their previous meeting to obtain data and information that showed the actions they are taking to resolve issues from the cyberattack. HHS reviewed the responses over the weekend of March 15. Payers then offered HHS updates on their resolution efforts towards providers and outlined specific actions they plan to take.

 “HHS and White House leadership pressed insurers to be targeted and specific in carrying out solutions, including increasing advanced payments where needed to the providers and communities still most in need,” HHS said in the press release.

As health systems slowly begin to get back on track with payments and regular operations, it’s clear that payers have been slow to act in this crisis and give aid to their providers and patients. As payers look for a balance between advancing payments without advancing fraud in this difficult situation, some providers are still struggling to keep their systems operational without the cash flow.