NEWS & INFORMATION |
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:
Eligibility requirements and required certifications from the Fact Sheet include:
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:
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
2024 FAHCS Annual Meeting & Exhibit Show |
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Jul 31 - Aug 1, 2024 Renaissance Orlando at SeaWorld Orlando, FL |
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