Warning to Healthcare Providers: Change Healthcare Cyberattack Sparks Cash Flow Crisis

Greetings Doctors, Therapists & Staff,

I hope by now that you are aware of the ransomware attack that Change Healthcare experienced last month. I’ve been monitoring the dozen, or so, healthcare news feeds I follow to keep track of the massive damage caused by this cyberattack, as well as any impending fixes on the horizon of which there hasn’t been much shared on that front. If you haven’t kept up with this story I’ll provide a brief recap.

In the wake of the February 2024 Blackcat ransomware attack on UnitedHealth Group-owned [UHC] Change Healthcare, the Department of Health and Human Services (HHS) has issued a stern warning to healthcare providers nationwide. The cyberattack, which incapacitated over 100 of Change Healthcare’s systems, has sent shockwaves through the industry, leaving providers scrambling to cope with severe cash flow problems.

Providers relying on Change Healthcare’s systems for crucial tasks like insurance coverage verification, claims submission, and payment processing have found themselves in dire straits. The fallout has prompted several industry groups to petition the HHS for assistance, citing the crippling impact on their members’ financial stability. According to recent statistics 94% of hospitals are experiencing a financial impact, and healthcare providers, in general, may be losing up to $100 million a day from the cyberattack.

UnitedHealth Group’s temporary financial assistance program has drawn criticism for its limited eligibility criteria and burdensome terms, exacerbating frustrations among affected providers. The HHS, while acknowledging the gravity of the situation, has emphasized the need for concerted efforts to minimize disruptions to patient care.

In response to mounting pressure, the HHS has rolled out a series of flexibilities aimed at alleviating the strain on healthcare providers. These measures include expedited processes for changing clearinghouses, relaxation of prior authorization requirements, and encouragement for payers to offer advance funding to affected providers.

Providers grappling with claims processing challenges are urged to reach out to their Medicare Administrative Contractor (MAC) for support. The CMS has instructed MACs to fast-track new electronic data interchange (EDI) enrollments and accept paper submissions if necessary.

Despite these efforts, concerns linger that the new flexibilities may fall short of addressing the full extent of providers’ financial woes.

The cyberattack on Change Healthcare serves as a stark reminder of the critical need to bolster cybersecurity resilience across the healthcare ecosystem. The HHS has reaffirmed its commitment to enhancing cybersecurity measures, urging stakeholders to prioritize cybersecurity with renewed urgency.

Providers are advised to stay vigilant and proactive in safeguarding patient data and financial stability. It is imperative that providers check with their clearinghouses to ascertain how they are addressing the aftermath of the cyberattack and safeguarding patients’ protected health information (PHI).

As the healthcare industry navigates the fallout from this cyberattack, the resilience and collaboration of providers, industry stakeholders, and government agencies will be crucial in mitigating the impact and ensuring the continuity of care for patients nationwide.

All that said, a couple more notes of importance here. For our clients, we continue to monitor for any denials via electronic submissions that are directly related to this cyberattack. Please be aware that many clearinghouses must funnel claims through Change Healthcare to reach the desired insurance carrier. This is one of the reasons why so many entities were against UHC being able to purchase Change Healthcare. It has created a near monopoly of sorts as UHC owns so many insurance entities [ie Optum, UMR, etc], or have very “interesting” ties to other insurers where deals are made that require e-claims to arrive via Change Healthcare. So, your clearinghouse may have to funnel certain claims to another clearinghouse [Change Healthcare] before it finds itself at the final insurer destination. These ties have potentially compromised those clearinghouses unrelated to Change Healthcare because of the cyberattack threat.

If you have recently noticed batches of e-claims denied, since February or early March, for reasons you’ve never experienced before it’s a good bet the Change Healthcare incident is behind it. In some cases we’ve been able to re-route the claims if our clients’ clearinghouse has already effected such a fix; in other cases, we may have to switch these e-claims to printed claims and mail them in. It’s a tedious and costly process as some insurance companies have continued to refuse paper claims regardless of the Change Healthcare matter, and even with HHS flashing warnings to insurers to allow for all methods of claims submissions until this is resolved. We also continue to get mixed messages from insurance companies when we call as sometimes we hear “go ahead and mail”, and sometimes we hear “don’t mail, they’ll just be trashed; give it time for the original problem to be fixed” – all this from the same insurance company!

We understand the financial stress this puts to all providers, but know we’re on it and will do what we can to get claims submitted as soon as possible. Know, too, we cannot repeatedly resubmit electronically through the same clearinghouse until the all-clear is issued. The claims will just continue to get denied or kicked out not to mention really anger the clearinghouse.

One critical proactive measure that each and every provider should take immediately is to place a call to your respective clearinghouse and ask them how they are affected by the Change Healthcare cyberattack; what are they doing to safeguard themselves and protect your patients’ PHI information; how can you get any of your denied e-claims submitted safely to the insurance carriers [have they developed a work-around]; when do they expect to be back at full e-claim submission capacity?

I hope this has helped to shed a little more light on what has been happening in the claims submission world due to this cyberattack, and how your claims may be affected now and in the near future. Use this opportunity as well to check on your own malware programs in your office and home systems.

Think you might require billing and collection services? Call us for a no obligation chat to discuss your needs, or any difficulties you may be experiencing with your insurance revenue management. We work and bill directly from your software, and our knowledge and experience in different software programs now exceeds more than a dozen programs! We also post your payments for you directly in your software! Mention you read this e-newsletter and we’ll waive your start-up fee!

***We are pleased to announce the EHR software we work out of has expanded and now includes the following: ChiroTouch, ACOM, PayDC, EZNotes, Eclipse, ChiroHD, Office Ally, ChiroFusion, zHealth, CollaborateMD, MediSoft, Jane App, and more! Don’t see yours on the list? We continue to expand every month! Call to find out more!

Yours in health and wealth,

Dr Art

Dr. Arthur I. LeVine
CEO & Founder, iCollect Medical Billing Services, LLC
Past President, Florida Chiropractic Assn.,
Board of Directors, Florida Chiropractic Assn.,
Chairman, Insurance Relations Committee, Florida Chiropractic Assn.,
Co-Chairman, Government Relations Committee, Florida Chiropractic Assn.,
Florida Representative, Congress of Chiropractic State Assns.,
7027 W. Broward Blvd., #229
Plantation, FL 33317
954-530-6232 Office
206-309-4925 Fax to Email

https://www.icollectmedicalbilling.com

Posted in Uncategorized |

eNewsletter 03122024

Cracking the Code: Navigating HEDIS, the Future of Low Back X-Rays, and a Possible Voice to Controvert

Dear Doctors, Therapists and Staff,

Ah, the joys of healthcare bureaucracy—where navigating through a maze of regulations can sometimes feel like deciphering ancient hieroglyphics (my apologies to hieroglyphics for the comparison). Enter HEDIS, the Healthcare Effectiveness Data and Information Set, a set of measures designed to keep us all on our toes, especially when it comes to determining the necessity of diagnostic procedures like low back x-rays. If you’re seeing low back x-ray denials from the likes of Blue Cross Blue Shield or Cigna read on!

First, let’s take a stroll down memory lane and uncover how HEDIS came to be. Picture a boardroom filled with suits, each one armed with a spreadsheet and a mission to standardize healthcare performance metrics. Voila! HEDIS was born—an acronym that strikes fear into the hearts of providers everywhere, like a required Part 7 of a National Board Exam (there isn’t one, but had you worried!).

Now, fast forward to the present day, where insurance companies wield HEDIS criteria like a double-edged sword. On one hand, they claim to champion quality care and cost-effectiveness. On the other hand, they’re silently rubbing their hands together, plotting ways to restrict access to diagnostic imaging to save a few bucks. HEDIS measures are supposed to serve as a yardstick for evaluating the performance of healthcare plans. As far as specialties like Chiropractic, HEDIS holds particular significance, especially when it comes to determining whether diagnostic imaging is necessary for conditions such as low back pain. HEDIS has sparked discussions about whether there should be coverage of low back x-rays as a medically necessary procedure. According to HEDIS, the decision to cover or not to cover hinges on factors such as severity of symptoms, the presence of red flags, and the effectiveness of conservative treatment.

Furthermore, within the HEDIS guidelines it is felt that diagnostic imaging studies for low back pain that are taken within 6 weeks of the initial visit are, in essence, medically unnecessary unless there is reason for the provider to suspect something much more serious such as cancer or an infectious process. It states that most low back pain sufferers recover within 6 weeks with conservative treatment, such as exercise, pain meds and physical therapy, and that low back diagnostic imaging would serve no additional benefit.

So, what does this mean for us Chiropractors? Well, brace yourselves, because these x-ray restrictions could throw a monkey wrench into our practices faster than you can say “subluxation” three times fast (you just tried it didn’t you). Suddenly, our hands are tied, forced to rely on outdated clinical guidelines and guesswork instead of hard evidence.

But wait, it gets better. Picture this: You’ve got a patient hobbling into your office, clutching their lower back like it’s a Saturday night winning lotto ticket although without the joy. They’re in agony, begging for relief. Normally, you’d order or take a low back x-ray without a second thought, but thanks to HEDIS, it’s a game of Russian roulette. Will it be covered? Will you have to jump through hoops to justify it? Would that even matter under HEDIS protocols?

And what about patient safety! Without timely access to diagnostic imaging, we’re flying blind, unable to rule out those potentially serious underlying conditions or tailor our treatment plans accordingly. In my early years in practice I had a patient present with severe low back pain and upon taking x-rays I discovered a massive abdominal aortic aneurysm. A seemingly innocent lumbosacral adjustment could have had devastating results. Not being able to utilize diagnostic x-rays at our professional discretion is like trying to navigate a minefield in the dark—risky business, to say the least.

So, what’s a Chiropractor to do in these trying times? Well, for starters, we can arm ourselves with knowledge, staying informed about the latest HEDIS updates and advocating for sensible healthcare policies. Pay attention to denial remarks on EOBs and ERAs for diagnostic x-rays that might actually state HEDIS as the denial protocol used [it might even mention the non-use of the 6 week cooling off period]. We can also flex our collaborative muscles, partnering with other healthcare providers such as primary care providers, orthopedists or neurologists that may also be involved in a case to ensure our patients receive the care they deserve.

It’s also imperative that your examination findings and documentation be complete, descriptive and supportive of the need to take those diagnostic x-rays right away. Any doubt, any absence, any lack of evidence to support your rationale for those films and the insurance denial based on HEDIS is inevitable.

There are other voices I would like to see speak out to help controvert systemic use of a denial protocol like HEDIS, or managed care plans that contractually deny Chiropractors coverage not only for diagnostic services, but simple examinations. I would be overjoyed if our malpractice carriers publicly weighed-in on these draconian measures by formally expressing to these insurers the importance of performing these services for the safety and protection of both patient and provider; as well as how these measures place a burden on their policyholders that could jeopardize their liability coverage should something go awry, and that could have been prevented if the diagnostic service had been performed.

In conclusion, HEDIS may be a thorn in our side, but it’s up to us to rise to the challenge and champion the best interests and safety of our patients. So, here’s to cracking the code, navigating the maze, and emerging victorious on the other side—x-ray restrictions be damned!

***We are pleased to announce the EHR software we work out of has expanded and now includes the following: ChiroTouch, ACOM, PayDC, EZNotes, Eclipse, ChiroHD, Office Ally, ChiroFusion, zHealth, CollaborateMD, MediSoft, and more! Don’t see yours on the list? We continue to expand every month! Call to find out more!

Yours in health and wealth,

Dr Art

Dr. Arthur I. LeVine

CEO & Founder, iCollect Medical Billing Services, LLC

Past President, Florida Chiropractic Assn.,

Board of Directors, Florida Chiropractic Assn.,
Chairman, Insurance Relations Committee, Florida Chiropractic Assn.,
Co-Chairman, Government Relations Committee, Florida Chiropractic Assn.,
Florida Representative, Congress of Chiropractic State Assns.,
7027 W. Broward Blvd., #229
Plantation, FL 33317
954-530-6232 Office
206-309-4925 Fax to Email
www.icollectmedicalbilling.com

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Posted in Uncategorized |

eNewsletter 02202024

From: Dr. Art LeVine @ iCollect Medical Billing

Navigating Medicare Changes for Chiropractors and Physical Therapists in 2024

Hello Doctors, Therapists and Staff!

If you haven’t gotten the love from me before let me say again, happy 2024, and nothing but blessings to you and yours this year, and every year hereafter!Speaking of hereafter, I know what you’re here after, which is a little information to help get you through another day in the rough and tumble world of insurance! In this go-around I’m going to focus on more of a reminder for both our Chiropractic and Physical Therapy offices. We’ve had several offices comment to us about values they are using for 2024 Medicare deductibles. The problem is that they are citing 2023 values and not the new 2024. So, I’ll address that and a couple other items in this e-newsletter. Let’s get to it!

In the dynamic landscape of healthcare, staying well-informed about Medicare Part B updates is crucial for Chiropractors and Physical Therapists. As we step into 2024, let’s delve into key changes in Medicare Part B and therapy service thresholds that directly impact these specialties.

Medicare Part B Annual Deductible:

For 2024, the annual deductible for all Medicare Part B beneficiaries is $240. This represents a modest increase of $14 from the previous year’s deductible of $226 in 2023. Chiropractors and Physical Therapists should communicate this information to their patients, ensuring transparency about potential out-of-pocket costs at the beginning of the year [Don’t forget about the “No Surprises Act”, too!].

Understanding the annual deductible is vital for all practitioners, as it directly affects billing processes and financial planning for both the healthcare provider and the patient. Being aware of these changes allows for more effective communication with patients regarding their Medicare coverage and potential financial responsibilities.

Therapy Services: Per-Beneficiary 2024 Threshold Amounts:

For 2024, Medicare introduced specific threshold amounts for therapy services. The KX modifier is applied to indicate that the services provided are medically necessary and meet Medicare’s criteria for coverage beyond the standard limits.

For 2024, the threshold amounts for therapy services are:

1. Physical Therapy and Speech-Language Pathology Services Combined:

· Threshold Amount: $2,330 – a $100 increase over 2023.

2. Occupational Therapy Services:

· Threshold Amount: $2,330 – a $100 increase over 2023.

Practitioners offering physical therapy, speech-language pathology, and occupational therapy services should take note of these threshold amounts. Once these thresholds are reached, the KX modifier becomes essential to continue receiving reimbursement for services deemed medically necessary. Any services billed after the threshold is reached, but missing the KX modifier will be denied.

It is crucial for Chiropractors and Physical Therapists to closely monitor their patients’ progress and ensure that documentation supports the medical necessity of continued therapy services. Additionally, effective communication with patients regarding these thresholds can help manage expectations and address potential financial considerations.

In light of Medicare’s strict documentation requirements, Chiropractors and Physical Therapists must maintain thorough and accurate records of patient encounters. Detailed documentation not only ensures compliance with Medicare regulations but also supports the necessity and effectiveness of the services provided. This documentation should include assessment findings, treatment plans, progress notes, and any relevant communication with other healthcare providers.

In conclusion, staying informed about Medicare Part B changes and therapy service thresholds is integral for Chiropractors and Physical Therapists in providing optimal care while navigating the evolving healthcare landscape. By understanding the annual deductible adjustments and therapy service thresholds, practitioners can enhance their financial planning, improve patient communication, and continue delivering high-quality services in 2024.

***We are pleased to announce the EHR software we work out of has expanded and now includes the following: ChiroTouch, ACOM, PayDC, EZNotes, Eclipse, ChiroHD, Office Ally, ChiroFusion, zHealth, CollaborateMD, MediSoft, and more! Don’t see yours on the list? We continue to expand every month! Call to find out more!

Yours in health and wealth,

Dr Art

Posted in Medicare |

eNewsletter 06282023

From: Dr. Art LeVine @ iCollect Medical Billing eNewsletter 6-28-2023

Hello Doctors and Staff,

I hope this eNewsletter finds you happy and healthy!

In case you were unaware, 6/30/2023 marks the date you must put into use the new CMS Advance Beneficiary Notice [ABN] form. This form has a tentative expiration date of 1/31/2026 (I say “tentative” because we are talking about the government, right!?). I have placed the CMS link to download the ABN form, in both English and Spanish, below.

Please remember that the ABN form is only meant for those services that are normally covered by Medicare, but where the provider feels Medicare will not reimburse because the provider has deemed the service maintenance care. For Chiropractic this would exclusively cover the three spinal manipulation codes [98940, 98941, 98942] which would be billed with the -GA modifier, instead of the -AT modifier which is only applicable for active care and not maintenance. The ABN form is NOT meant to be used for all other services, which are considered “statutorily non-covered”. In my opinion and experience, it would be a very smart and prudent idea to create a form on your letterhead that basically says something like,

“Dear Patient, Dr. ______ has deemed that the following services are [important, necessary, integral, etc] to determine the cause and extent of your condition (ie, exams, xrays, etc); also, the doctor has deemed that the following services are [important, necessary, integral, etc] to speed and improve your recovery [physical therapies, strapping/taping, braces, etc].

Medicare has stated these services are “statutorily non-covered” when performed by a Chiropractic physician, therefore, you will be responsible for these charges.” Have the patient sign that form, date it, give them a copy and you keep the original.

This way, down the road, if they contest that you never informed them of this responsibility, or forget, or think they should be receiving some form of reimbursement from Medicare you’ll have the proof that you informed them of the rule, the price (based on the relatively new Good Faith Estimate requirement), and they signed the form!

Get this ready for the 6/30/23 start!

https://www.cms.gov/medicare/medicare-general-information/bni/abn

Yours in health and wealth,
Dr. Art

Dr. Arthur I. LeVine

CEO & Founder, iCollect Medical Billing Services, LLC
Past President, Florida Chiropractic Assn.,
Board of Directors, Florida Chiropractic Assn.,
Chairman, Insurance Relations Committee, Florida Chiropractic Assn.,
Co-Chairman, Government Relations Committee, Florida Chiropractic Assn.,
Florida Representative, Congress of Chiropractic State Assns.,

Past Florida Contractor Advisory Council (CAC) Representative
7027 W. Broward Blvd., #229
Plantation, FL 33317
954-530-6232 Office
206-309-4925 Fax to Email
www.icollectmedicalbilling.com

Posted in Medicare |

eNewsletter 0221202

From: Dr. Art LeVine @ iCollect Medical Billing eNewsletter 02212023

Hello Doctors and Staff!

I hope your 2023 has started off in grand fashion and that your New Year’s resolutions are well underway!

I had wanted to get this information out to everyone towards the end of January, but the new Congress, specifically the House of Representatives, had just a couple of delays getting their own house in order. Once that side-show was seemingly over there was chatter that they may attempt to do a deep dive into chopping so-called entitlement programs such as Medicare and Social Security, and begin primarily by targeting the 2023 Medicare program mainly focusing on the fee schedule and covered benefits. Such changes could have quite the ripple-effect, especially here in Florida, as it would not only affect reimbursements for straight Medicare patients, but PIP reimbursements, and even Medicare Advantage plans. So, yours truly didn’t want to release the 2023 Medicare fee schedules to you approved by Congress in November 2022 if there was going to be another re-vamp of those figures.

As a reminder, healthcare providers were originally preparing for as much as 8.5% in reimbursement cuts from Medicare to many covered services. More than 150 provider groups and organizations successfully rallied together to petition Congress and Medicare to stop such draconian measures at a time when rising costs and inflation were already affecting healthcare practices. So, rather than an immediate 8.5% cut right away to those earmarked services a 2% rollback was put in effect for 2023, and then 1.25% for 2024. Of course, the House and Congress can shake up this etch-a-sketch box [apologies to late Millennials and Gen Z’ers – ask your parents if you don’t know what that is] and erase it all at their whim, so it’s best to digest this a year at a time and see how the literal pieces fall. Also, keep your ears open for discussions about Medicare physician payment reform to create stability in the program as was recently suggested by the current president of the AMA.

Be this all as it may, the House apparently has taken on more than what they can find common ground on, it’s past the mid-point in February, and my trigger finger to hit “Send” and get this love note out to you was beyond itchy – so here we are.

Our billing and collection clients can request the last approved fee schedule for their Locality, and all others can request the link to download their fee schedules as well.

On a tangential note, we’ve been noticing that a few offices are still using the old Medicare Part B deductible amount from 2022. Please note that the 2023 Medicare Part B deductible is $226 which is a $7 decline from 2022. This could also have an effect on some Medicare Advantage plans so be sure to verify the insurance coverage of those and all other plans. If you over-collected from your Medicare patients you must credit or return the overage amount to the patient.

Last, providers and staff must keep vigilant in watching for emails from Medicare’s PECOS system. PECOS is the Provider Enrollment, Chain, and Ownership System. Medicare, or CMS, verifies physicians’ status by using its provider enrollment database and if a physician does not have an approved enrollment record Medicare will not pay for services provided to those patients. PECOS will randomly require providers to revalidate their information in order to stay in their good graces. If you have not checked or verified your status with CMS in the past year I would strongly suggest you do so right away, and then calendar to check this site every six months to ensure your registration, revalidation, and compliance. You should check your status at https://pecos.cms.hhs.gov.

Think you might require billing and collection services? Call us for a no obligation chat to discuss your needs or any difficulties you may be experiencing with your insurance revenue management. We work and bill directly from your software, and our knowledge and experience in different software programs now exceeds more than a dozen programs! We also post your payments for you directly in your software! Mention you read this e-newsletter and we’ll waive your start-up fee!

DISCUSSION QUESTIONS

1. Have you ever visited a Member of Congress in Washington, DC? Extra credit if you were inebriated at the time. Double credits if they were inebriated at the time.

2. Did you have an etch-a-sketch growing up? Was it mine [I’d like it back, please]?

3. Do you know what percentage of your practice is affected by Medicare reimbursement rates [Medicare, Medicare Advantage, Managed Care plans that use Medicare fee schedule, PIP, etc]?

Yours in health and wealth,

Dr. Art

Past Florida Contractor Advisory Council (CAC) Representative
7027 W. Broward Blvd., #229
Plantation, FL 33317
954-530-6232 Office
206-309-4925 Fax to Email
www.icollectmedicalbilling.com

Posted in Medicare |

iCollect Medical Billing Services, LLC