- March 13, 2024
- Alerts
CMS Announces Payment Program for Providers Impacted by Change Healthcare Cyberattack
On March 9, 2024, the U.S. Department of Health and Human Services and Centers for Medicare & Medicaid Services (CMS) announced it will make available Change Healthcare/Optum Payment Disruption accelerated payments to Part A providers and advance payments to Part B suppliers experiencing potentially significant cash-flow problems as a result of the recent cyberattack on UnitedHealth Group’s subsidiary Change Healthcare/Optum (CHOPD Payments).
Eligible providers/suppliers impacted by the cyberattack are encouraged to contact their regional Medicare Administrative Contractors to apply for CHOPD Payments. However, providers/suppliers may find the repayment terms of such payments challenging given their potential cash-flow problems. The repayment terms require that providers/suppliers acknowledge, among other things, that these payments are not loans and will not be subject to forgiveness, reduction negotiation, or flexibilities in repayment timelines. Moreover, CHOPD Payments will be immediately eligible for repayment via 100% recoupment for the first ninety (90) days. On Day 91, CMS will issue a demand, inclusive of applicable interest, for any remaining balance owed by the CHOPD recipient.
Determining Eligibility[1]
Providers/suppliers applying for the CHOPD Payments must make 13 separate certifications, including, for example, that the provider/supplier “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.”
Other requirements include, but are not limited to, that the provider/supplier must:
Determining CHOPD Payment Amount
Additionally, affected providers/suppliers must choose one of two calculation options to determine the amount of CHOPD Payments:
Should you have any questions regarding the above, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.
Eligible providers/suppliers impacted by the cyberattack are encouraged to contact their regional Medicare Administrative Contractors to apply for CHOPD Payments. However, providers/suppliers may find the repayment terms of such payments challenging given their potential cash-flow problems. The repayment terms require that providers/suppliers acknowledge, among other things, that these payments are not loans and will not be subject to forgiveness, reduction negotiation, or flexibilities in repayment timelines. Moreover, CHOPD Payments will be immediately eligible for repayment via 100% recoupment for the first ninety (90) days. On Day 91, CMS will issue a demand, inclusive of applicable interest, for any remaining balance owed by the CHOPD recipient.
Determining Eligibility[1]
Providers/suppliers applying for the CHOPD Payments must make 13 separate certifications, including, for example, that the provider/supplier “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.”
Other requirements include, but are not limited to, that the provider/supplier must:
- Not be receiving periodic interim payments;
- Be unable to submit electronic claims to receive payments from Medicare;
- Have experienced a disruption in claims payment or submission due to a business relationship that they or their third-party payers have with Change Healthcare or another entity that uses Change Healthcare or requires the provider/supplier to use Change Healthcare;
- Not be under active medical review or a program integrity investigation;
- Not have any outstanding delinquent Medicare overpayments; and
- Not be on a Medicare payment hold or payment suspension.
Determining CHOPD Payment Amount
Additionally, affected providers/suppliers must choose one of two calculation options to determine the amount of CHOPD Payments:
- The maximum allowable amount, as calculated by CMS, which will represent an average of thirty (30) days of Medicare claims payments paid to the provider/supplier between August 1, 2023 and October 31, 2023, divided by three; or
- A specific amount not to exceed the maximum allowable amount.
Should you have any questions regarding the above, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.