The recent cyberattack on Change Healthcare has created unprecedented challenges for healthcare providers, particularly in the realm of revenue cycle management (RCM) and denials management. Many providers who relied on Change Healthcare for billing services have found themselves in a difficult position, forced to quickly switch to new billing practices and facing a backlog of claims. A critical problem stemming from this situation is the increased rate of claim denials based on timely filing deadlines, particularly evident in payers’ widespread rejection of claims submitted.
Let’s explore strategies for hospital and healthcare systems to manage these timely filing denials effectively while maintaining their current operations.
Understanding the Scope of the Problem
The Change Healthcare cyberattack has disrupted normal billing processes, causing delays in claims submissions that extend beyond standard timely filing deadlines. This has resulted in a wave of denials that, if not addressed properly, could lead to significant revenue losses for healthcare providers. The situation is further complicated by the need to simultaneously manage current claims while dealing with the backlog created by the cyberattack.
Strategies for Managing Timely Filing Denials
Identify and Utilize Available Resources
The first step in addressing timely filing denials is to identify and leverage available resources:
- Payer Websites: Many payers have recognized the extraordinary circumstances and have posted information about adjustments or alternative solutions. Some have placed guidelines on their websites outlining flexible workarounds for providers to follow. Providers should regularly check the websites of all payers they work with for similar guidance.
- Professional Associations: Organizations like the American Medical Association (AMA) have stepped up to offer resources and guidance specific to the Change Healthcare cyberattack. These resources often include best practices for managing denials and navigating payer relationships during this crisis.
Comprehensive Documentation
Thorough documentation is imperative when appealing timely filing denials. Gather and organize the following:
- Detailed timeline of the cyberattack’s impact on your billing processes
- Records of your relationship with Change Healthcare and the transition to a new billing service or practice
- Logs of attempts to submit claims during the outage and transition period
- Correspondence with payers regarding the situation
- Documentation of any workarounds or interim measures implemented
This documentation will serve as crucial evidence when appealing denials and negotiating with payers.
Strategic Appeals Process
Develop a robust appeals process specifically tailored to address timely filing denials related to the cyberattack:
- Bulk Appeals: Given the systematic nature of these denials, consider submitting bulk appeals. This approach can be more efficient and may help highlight the widespread impact of the cyberattack on your claims submission process.
- Customized Appeal Letters: Craft detailed appeal letters that clearly explain how the Change Healthcare cyberattack directly impacted your ability to submit claims within the standard timely filing window. Include all relevant documentation and emphasize the extraordinary nature of the situation.
- Leverage Technology: Utilize software specific to denials management to track appeals, set reminders for follow-ups, and analyze patterns in denials. This can help streamline the appeals process and ensure no claims fall through the cracks.
Engage Payers Proactively
Proactive communication with payers is essential in addressing timely filing denials:
- Leverage your managed care or contracting department to engage with payer representatives
- Request dedicated contact persons for resolving issues related to the cyberattack
- Seek clarification on any temporary policies or flexibilities being offered regarding timely filing limits
- Negotiate extensions on timely filing deadlines, emphasizing the extraordinary circumstances
- Discuss the possibility of retrospective claim reviews or special consideration for claims affected by the cyberattack
Outsource to Vendor Partners
Given the volume of denials and the complexity of the situation, consider outsourcing some or all of your denials management to specialized vendor partners. This strategy offers several benefits:
- Allows your internal team to focus on current claims and maintain ongoing operations
- Leverages the expertise of professionals who specialize in denials management and appeals
- Provides access to advanced technologies and processes that can streamline the appeals process
- Offers scalability to handle the surge in denials without overwhelming your staff
When selecting a vendor partner, look for those with:
- Experience in handling large-scale denials management projects
- Familiarity with the specific challenges posed by the Change Healthcare cyberattack
- Robust technology platforms for tracking and managing appeals
- Strong relationships with major payers
Prioritize and Triage
Implement a system to prioritize and triage denials:
- Focus on high-value claims first to maximize potential recoveries
- Categorize denials based on payer, denial reason, and potential for successful appeal
- Create a separate workflow for cyberattack-related timely filing denials to ensure they receive appropriate attention
Enhance Internal Processes
Use this challenging time as an opportunity to review and enhance your internal RCM processes:
- Conduct a thorough review of your claims submission workflows to identify any vulnerabilities or inefficiencies
- Implement additional quality checks to ensure clean claims are being submitted, reducing the likelihood of other types of denials
- Cross-train staff on various RCM functions to increase flexibility and resilience
- Develop or update contingency plans for future disruptions
Leverage Data Analytics
Utilize data analytics to support your denials management efforts:
- Analyze patterns in timely filing denials to identify any payer-specific trends
- Use data to support your appeals by demonstrating the stark increase in denials coinciding with the cyberattack
- Track appeal success rates to refine your approach and focus efforts on the most effective strategies
Stay Informed and Adaptable
The situation continues to evolve, and providers must stay informed and adaptable:
- Regularly check for updates from Change Healthcare, payers, and industry associations
- Be prepared to quickly implement new processes or technologies as alternative solutions become available
- Share best practices and challenges with peer organizations to foster industry-wide learning and improvement
Remember, while the immediate focus is on addressing the current crisis, this experience also offers valuable lessons for building more resilient RCM workflows for the future. By adapting and innovating in response to this challenge, healthcare providers can emerge stronger and better prepared for whatever the future may hold.
