Payers, providers continue to tussle over Change Healthcare cyberattack response

Providers are still feeling the pain brought on by the cyberattack on Change Healthcare, and they're continuing to push insurers and the feds to beef up their responses.

For example, they're seeking relief around prior authorization and utilization management to keep claims payments moving amid delays, and the Department of Health and Human Services (HHS) has backed this step, urging payers to streamline these processes.

However, AHIP, the leading insurance lobbying group, said in a statement Thursday that there are risks to potentially offering exemptions broadly for prior auth.

“Given the very wide variability of impact across the system, individual plans and providers are in the best position to assess how to maintain appropriate payments in a timely manner—and also to minimize the need for reconciliation processes," AHIP CEO Mike Tuffin said. "Further, broad exemptions in prior authorization at a time of advanced payments could expose patients and employers to fraud, waste and unnecessary costs."

The American Medical Association (AMA) fired back, calling the response "tone-deaf" in the face of the financial challenges providers are facing.

“It is dumbfounding that following weeks of silence and a lack of assistance to struggling practices in the wake of the Change Healthcare cyberattack, AHIP’s response is a 'business as usual' approach to prior authorization," AMA President Jesse Ehrenfeld, M.D., said in a statement. "This approach is particularly galling since service outages have exacerbated the administrative burdens and care delays already associated with this process. Prioritizing profits over the stability and solvency of our care delivery system starkly contrasts with the Biden Administration’s appeal to health plans to 'meet the moment.'"

Providers have also criticized UnitedHealth Group's individual response to the cybersecurity incident, including its program to offer temporary funding to cover missing claims payouts.

The American Hospital Association (AHA) is urging Congress to take a look at statutory limitations that may prevent HHS and the Centers for Medicare & Medicaid Services from being able to fully support providers as they navigate the disruption.

In a letter (PDF) to the chair and ranking member of the Senate Finance Committee, the AHA urged the panel to examine those hurdles to ensure a complete response is possible.

"We are concerned that this program is limited in its impact due to certain statutory constraints, including the repayment timeline and interest rate on AAPs," AHA wrote. "In addition, we still need to address what is likely to be a substantial problem on the backend: excessive denials by payers of claims that either could not be filed timely or because the provider could not obtain the necessary authorization."

"In short, providers still need certainty that they will not face billions in denials for technical reasons beyond their control as a result of the Change Healthcare outage," the organization added.

The financial struggles providers have faced in the wake of the cyberattack have had a massive impact, and new data from Kodiak Solutions highlight just how significant those impacts have been. The analysts studied data from more than 1,850 hospitals and 250,000 physicians and found that claims submitted to health insurers have decreased by one-third since the incident began in late February.

Kodiak Solutions, which provides financial reporting and revenue cycle management software, found that the cash value of claims submitted through its Revenue Cycle Analytics database dropped by more than a quarter in the first week after the cyberattack and has now fallen to 63%.

The cash flow of the claims that have been delayed ranged from $1.84 billion in the first week to $2.53 billion in the latest full week, according to the study. The total effected cash flow for claims processed through Kodiak's platform is $6.3 billion as of March 9.

“And the impact will grow over time, even after claims processing returns to normal,” said Colleen Hall, senior vice president and revenue cycle leader at Kodiak Solutions, in a press release. “We expect this interruption of claims processing to also increase insurance denials for medical necessity, prior authorization and timely filing.”