Have You Been CHOPD?

Have You Been CHOPD?

The recent cyberattack on UnitedHealth Group’s subsidiary Change Healthcare, also known as Optum, has sent shockwaves through the medical community. This incident, which unfolded in late February, has created unprecedented challenges for healthcare operations nationwide. The Centers for Medicare & Medicaid Services (CMS), under the umbrella of the U.S. Department of Health and Human Services (HHS), has stepped up in response to the turmoil, working closely with UnitedHealth Group and Change/Optum to mitigate the impact on providers and suppliers.

As the healthcare sector grapples with significant operational disruptions, including difficulties in submitting claims and receiving Medicare payments via the Change Healthcare platform, CMS has taken decisive action to ensure the continuity of care. Recognizing the critical cash flow problems facing providers and suppliers due to these unusual circumstances, CMS has initiated the Change Healthcare/Optum Payment Disruption (CHOPD) program. This initiative offers a lifeline to Part A providers and Part B suppliers experiencing claim disruptions as a direct result of the cyberattack.

Announced on March 9, the CHOPD program provides accelerated payments to Part A providers and advance payments to Part B suppliers, offering much-needed financial relief. Eligible entities can receive amounts equivalent to up to 30 days of claims payments, based on an average calculated from payments made between Aug. 1, 2023, and Oct. 31, 2023. These funds, designed to be repaid through automatic recoupment from Medicare claims over 90 days, with any remaining balance due on day 91, aim to stabilize operations and maintain the provision of care.

Beyond the immediate financial support, CMS is urging providers and suppliers to maintain communication with all their payors for updates on receiving timely payments and exploring any additional short-term funding programs. The agency is also encouraging Medicare Advantage (MA) organizations to extend advance funding to those most affected by the cyberattack while reminding stakeholders that the rules governing payments to MA organizations and Part D sponsors remain unchanged.

Eligibility for the CHOPD program requires providers and suppliers to hold unique National Provider Identifier (NPI) and Medicare ID (PTAN) combinations, with certain entities, like those receiving Periodic Interim Payments, being ineligible. Applicants must certify their inability to submit claims, the disruption experienced due to their business relationship with Change Healthcare, a lack of sufficient funding from other sources, and their intention to continue operations, among other criteria.

This proactive approach by CMS reflects a broader commitment to supporting the healthcare sector in times of crisis. As we navigate the aftermath of the cyberattack, the importance of the role of CMS in coordinating efforts to minimize disruption and ensure the stability of healthcare operations cannot be overstated. The CHOPD program represents a crucial step towards recovery, providing a financial buffer for providers and suppliers facing unprecedented challenges.

In conclusion, CMS’s swift action in the wake of the Change Healthcare cyberattack exemplifies the critical role of government agencies in safeguarding healthcare operations against cyber threats. By offering financial support and encouraging collaboration across the sector, CMS is helping to ensure that providers and suppliers can continue to offer essential services without interruption. As the situation evolves, the healthcare community remains hopeful that these measures will alleviate the immediate challenges posed by the cyberattack, paving the way for a stronger, more resilient healthcare system.

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Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

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