The daunting wave of anticipated increased denials due to the cyberattack on Change Healthcare back in February has now landed on overwhelmed hospitals and health systems, many of which are drowning in a sea of denied claims.
Because Change Healthcare provides technology used by hundreds of health systems to electronically submit and process billions of claims, healthcare providers were stunned this spring when they suddenly could no longer submit claims information to payers electronically via the clearing houses and portals that they had been using before the cyberattack. This stoppage triggered both clinical and technical denials and has created a tremendous financial burden on hospitals, as well as an enormous backlog for providers to contend with.
It's important that providers understand their rights and have a plan to deal with this new flood of denials. To help hospitals and health systems tackle this challenge, here are some strategies to consider:
Communication with payers is key
It’s critical for providers to reach out to payers and explain the steps that have been taken.
“It’s going to be impactful when you’re receiving a denial to say to the payer, ‘We couldn’t notify you electronically like we always have, but these are the things that we did. Here are the workarounds we initiated while the technology was down,’” says Gloriann Sordo, President of Denials Operations at Aspirion.
“Engage with the department leaders impacted by the cyberattack to understand what they did to overcome the missing technology to see how it may impact impending denials and, most importantly, be sure payers know all the efforts done by the hospital to demonstrate to the payer that we didn’t just sit back and do nothing.”
Hospitals and health systems should be talking to their payers or their payer representatives and asking how they can help the situation.
Coordinate with your team
If a hospital was not able to put a manual authorization process in place while the services were down, decide who is going to manage what types of denials before they come in.
“Decide who is going to take that first attempt,” says Sordo. “Get a plan of attack in place. Evaluate your toolbox. Your tools and data used prior to the cyberattack may be different than the tools or practices you’ll put in place post attack.”
Aside from their toolbox, it’s also important for providers to review and adjust their workflows where needed. It won’t always be possible to plug in the same resources or methodology to manage a no-authorization denial post-attack as they would have before the attack.
Document, document, document
Maintaining detailed documentation in the notes of each account about the steps that providers attempted to compensate for the missing services is imperative.
“While you were going through the stoppage from the cyberattack, how were you working around it?” asks Sordo. “When you’re creating your appeal be specific about sharing the efforts you put in place to continue to meet the payer’s administrative requirements.”
Part of the process, too, is for providers to gather any documentation they can on what payers have said regarding how they're going to work with health systems.
Be informed
Providers should use to their advantage any interim policies, procedures, or protocols that payers put in place.
“These interim policies, know them. Talk about them. Ask about them when you're in your meetings,” says Sordo. “I would tell my providers, ‘Go to your managed care departments and ask them, Are you aware of any adjustments? Any special procedures that the payers are putting in place to help us with the denials that we anticipate because of the Change cyberattack?’”
Education and training are a must
Hospitals should be providing education and training for anybody who's involved in their denials management process. Team members need to be aware of timelines and specific steps that should be taken. Everyone on the team needs to be debriefed, especially those individuals who are writing appeals.
“Most importantly, the experts that you have writing your appeals, include them so they have awareness on how they should utilize that information to their advantage,” says Sordo.
Appeal and advocate for your position
“If I could give one parting piece of advice to my providers, it's appeal and advocate for your position,” says Sordo. “You were dealt a hand that you did not expect. Advocate with your managed care department. Work closely with your provider representatives and appeal. Find a way. Do whatever it takes. Don't roll over on these. Seek the advice of experts. If you’re drowning in a flood of denials, there are resources out there for you.”