by AJ Riviezzo
When all of this started with Change Healthcare (the United Health clearinghouse) being ransomware/hacked, I hesitated in writing anything as the issues seemed dynamic and ever changing. A few things are pretty clear now.
Change has not been able to just flip a few switches and become operational again. For the past three weeks we have been told it would be working again ‘next week’. We have not heard a specific date from Change regarding when their services will resume.
Some Electronic Health Record/Practice Management softwares like StreamlineMD are working to migrate to a different clearinghouse. This is, unfortunately, not a fast process either. The other clearinghouse companies were not sitting around with extra staff waiting for more work. Medicare also requires the new clearinghouse to essentially register on the practice’s behalf with Medicare as a fraud prevention tool. This can take up to three weeks. While Medicare has stated they will expedite these requests, Medicare is likewise experiencing a volume of these documents they are not used to seeing either.
Medicare and some payers require electronic submission of claims. Medicare did just come out stating that some practices may be able to send paper claims. Frankly, given that Medicare was likewise not sitting around with extra staff (I presume) prepared to receive and process paper claims, I do not see this as a viable option. Waiting for Change to become operational or a transition to a new clearinghouse will likely be faster.
For those commercial payers that will accept paper claims, we have been sending paper claims for all ablations. Over 50% of a phlebology practices revenues are typically the ablation claims. Sending paper claims to any payer is always problematic in terms of processing speed, lost claims, and the like. We are limiting what we are sending in the hopes of maintaining a good bit of the revenue stream while not overwhelming the paper processes.
In short, it is still a mess. My practices that used Change as their clearinghouse are being directly impacted. Downstream I am directly impacted. It is mind boggling that a company as large and well-funded as Change could end up in this position.