The Change Healthcare ransomware attack has sown chaos in the healthcare industry.
Hospitals whose revenue streams have suddenly dried up are hurtling toward a financial cliff; smaller providers face even starker realities. To weather this storm, everyone—from large hospitals to boutique providers—needs to prioritize three things to keep revenue coming in and their businesses solvent.
Priority 1: Resume Claims Submission
Cash keeps your business alive, but you cannot maintain an active cashflow without submitting claims and collecting payment. If you relied heavily on Change Healthcare for claims, you may be wondering how to get back on track when the source of your cashflow is out of commission. Even if you didn’t solely rely on Change Healthcare, your other partners may have, and they are scrambling. You must get your claims moving again to ensure cashflow.
The great news is that roughly 90-95 percent of claims, whether Change Healthcare is up or down, have routes through other clearinghouses. The market has fast, capable clearinghouse options, and some of them can get you submitting claims the same day you sign up. Choose a clearinghouse that will be proactive on your behalf because that will get you up and running faster.
To expedite the process, make sure to provide your new clearinghouse with a list of payers where you send claims so that they can create a migration plan. As you can imagine, this process will vary widely depending on the size of your organization, the number of providers and the number of payers you have. A good vendor will help you through this critical process.
Priority 2: Address Unallocated Funds
Once claims payments start coming in, you have to figure out where they belong. Normally, your 835s (remits) help you sort out the patients and procedures to whom the funds are allocated. But there’s a problem: the vast majority of 835s require EDI enrollment, and these enrollments can take 2-6 weeks to get processed. If you’ve chosen a good clearinghouse partner, it is doing everything it can to expedite those enrollments on your behalf. But what do you do in the meantime?
Your first step should be to go to each payer portal and download the 835 forms manually. You need to take this step because, until your new clearinghouse is authorized to receive remits, your old clearinghouse receives the 835 forms, which doesn’t do you any good if they can’t send them to you. Not only is this step a pain, it’s also completely outside the usual RCM processes and procedures. The clearinghouse has always taken care of it! But during this period of crisis, you will have to take the initiative to obtain the 835s to reconcile accounts until the remits start to flow through your new clearinghouse.
If you have to set aside other business needs for a short time to manage these manual processes, don’t hesitate to do it. Getting paid and reconciling your accounts must be a priority.
Priority 3: Verify Eligibility and Benefits
Next, don’t forget the proactive step of verifying eligibility and benefits. Many health systems and hospitals had automatic verification systems, and the sudden halt of information is crippling. If you don’t currently have access to automatic eligibility and benefits verification, you still need to prioritize this process so you don’t hamper your cashflow later.
A good clearinghouse partner will help you process eligibility and benefits verification. Some will let you create a batch file of your upcoming schedule with patients, their insurance companies, and the services they are scheduled to receive. Your clearinghouse can then process those patients and obtain the appropriate information so that you know your patients’ coverage for the services they’re seeking. In addition, look for a clearinghouse partner whose portal lets you perform one-off eligibility and benefits verification in real time so that you can pull a patient’s information quickly and proceed with their visit.
Conclusion
Keeping your business running solidly during a crisis means prioritizing the most important aspects of your organization. If you don’t get paid, you can’t pay your people and you can’t keep the lights on (literally and figuratively). The good news is you’re not stuck.
Office Ally is a clearinghouse alternative you can trust. We can help you get payments moving again. You can start submitting claims today with Service Center, a portal powered by Office Ally’s all-payer Clearinghouse and more than 3,000 connected payers. We have specialized implementation plans for large volume submitters. Contact us today.