CMS to Offer Advance Payments for DME and Other Part B Suppliers Impacted by the Change Healthcare Disruption

On Saturday, CMS announced that, in addition to considering applications for accelerated payments for Medicare Part A providers, the Agency will also consider applications for advance payments for Part B suppliers impacted by the Change Healthcare/Optum Payment Disruption (CHOPD).

A related Fact Sheet issued on Saturday summarizes the scope of the relief and repayment guidelines:

  • The CHOPD accelerated and advance payments may be granted in amounts representative of up to thirty days (30) of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider/supplier between August 1, 2023 and October 31, 2023, divided by three. These payments will be repaid through automatic recoupment from Medicare claims for a period of 90 days. A demand will be issued for any remaining balance on day 91 following the issuance of the accelerated or advance payment.

Eligibility requirements and required certifications from the Fact Sheet include:

  • CHOPD accelerated and advance payments must be requested for individual providers/suppliers – i.e. unique National Provider Identifier (NPI) and Medicare ID (PTAN) combinations.
  • The provider/supplier has experienced a disruption in claims payment or submission due to a business relationship the provider/supplier, or the provider’s/supplier’s third-party payers, has with Change Healthcare or another entity that uses Change Healthcare or requires the provider/supplier to use Change Healthcare.
  • 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.

CMS’ release also notes that DME MACs will provide public information on how to submit a request for a Medicare accelerated or advance payment on their websites soon. As of this morning (3/11/24) Jurisdiction A and Jurisdiction D have updated their Change Healthcare Security Incident pages to include a link to the request template document. Check the related Jurisdiction B and Jurisdiction C pages for additional updates.

Resources and Links

UHG and CGS Share Guidance, Timelines & Resources on Change Healthcare Disruption

UnitedHealth Group (UHG) has released an update on expected timelines for Change Health to resume operations and additional guidance on UHC Medicare Advantage authorization for DME and their temporary funding program. In addition, DME MAC Jurisdiction B & C contractor CGS has provided additional information on resources to help take advantage of recently issued CMS flexibilities.

UHG DME Prior Authorization

UHG’s latest release states “For Medicare Advantage plans, including Dual Special Needs Plans, we are temporarily suspending prior authorizations for most outpatient services except for Durable Medical Equipment [emphasis ours], cosmetic procedures and Part B step therapies.”

UHG Temporary Funding Relief Program

The release also notes that Optum is expanding its provider funding program “to include providers who have exhausted all available connection options, and who work with a payer who has opted not to advance funds to providers during the period when Change Healthcare systems remain down.”

The update also adds more detail on repayment requirements: “For those who receive funding support, there are no fees, interest or other associated costs with the assistance. For repayment, providers will receive an invoice once standard payment operations resume and will have 30 days to return the funds. These terms now apply to both the original and expanded funding programs.”

UHG Timeline Restoring Change Healthcare Systems

UHG also asserts that, assuming the current rate of progress, they expect key system functionality to be restored and available on the following timelines:

  • Pharmacy services: Electronic prescribing is now fully functional with claim submission and payment transmission also available as of today. We have taken action to make sure patients can access their medicines in the meantime, including Optum Rx pharmacies sending members their medications based on the date needed.
  • Payments platform: Electronic payment functionality will be available for connection beginning March 15.
  • Medical claims: We expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.

CGS Resources to Help Take Advantage of HHS Flexibilities

As we reported on Mar. 5, HHS announced actions and flexibilitiesto alleviate potential operational disruptions and reimbursement delays. Today, DME MAC contractor CGS shared specific CGS resources that align with the flexibilities outlined in the HHS statement, including:

Resources and Links

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