Recognizing the ongoing impact of the cyberattack experienced by Change Healthcare/Optum on February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) announced over the weekend that it will allow Part A providers to apply for accelerated payments and Part B suppliers to apply for advance payments if experiencing claims disruptions as a result of the cyberattack.

Eligible providers and suppliers may request a payment amount of up to the average value of 30 days of claims payments, calculated based on the total claims paid (i.e., both Part A and Part B claims) between August 1, 2023 and October 31, 2023, divided by 3. Providers and suppliers will need to apply for accelerated or advance payments through their Medicare Administrative Contractor (MAC).

Eligibility Requirements

The CMS Fact Sheet explains that providers and suppliers with unique National Provider Identifier and Medicare ID combinations are eligible for CHOPD accelerated and advance payments, but providers receiving periodic interim payments are not eligible for accelerated payments.

In the payment request, the provider or supplier must certify that it:

  • Is unable to submit electronic claims to receive payments from Medicare.
  • Has experienced a disruption in claims payment or submission due to a business relationship that it has or its third-party payers have with Change Healthcare or another entity that uses Change Healthcare or requires the provider/supplier to use Change Healthcare.
  • Has been unable to obtain sufficient funding from other available sources to cover the disruption in claims payment, processing, or submission attributable to the cyberattack (e.g., CMS encouraged working with liability insurers to determine whether coverage for the disruption is available or exploring whether additional funding programs are offered by any other payers).
  • Does not intend to cease business operations and presently is not insolvent.
  • If currently in bankruptcy, will alert CMS about this status and include case information.
  • Based on its best information, knowledge, and belief, is not aware that it or a parent, subsidiary, or related entity of the provider/supplier is under an active healthcare-related program integrity investigation in which the provider/supplier or a parent, subsidiary, or related entity of the provider/supplier: (1) is under investigation for potential False Claims Act violations related to a federal healthcare program; (2) is a defendant in state or federal civil or criminal action (including a qui tam False Claims Act action either filed by the Department of Justice (DOJ) or in which DOJ has intervened); (3) has been notified by a state or federal agency (including a state or federal prosecutor, the HHS Office of Inspector General (OIG), or CMS (including its contractors, such as the Unified Program Integrity Contractors)), that it is a subject of a civil or criminal investigation or Medicare program integrity administrative action (e.g., revocation of enrollment or payment suspension); or (4) has been notified that it is the subject of a program integrity investigation by a licensed health insurance issuer’s special investigative unit (or similar entity).
  • Is enrolled in the Medicare program and has not been revoked, deactivated, precluded, or excluded by CMS or OIG.
  • Does not have any delinquent Medicare debts.
  • Is not on a Medicare payment hold or payment suspension.
  • Will use the funds for the operations of the specific provider/supplier for which they were requested.

Terms and Conditions

Providers and suppliers are required to acknowledge and agree to the terms of the payment program. Applicants should be aware that these payments represent an advance on claims, are not loans, cannot be forgiven, and do not have flexible repayment timelines. Repayment will commence immediately, with CMS recouping 100% of the Medicare claims payments owed to the provider or supplier for claims submitted and processed after the date on which the payment is granted.  Recoupment continues for 90 days, after which CMS will issue a demand for any remaining balance.  Interest will begin to accrue 30 days after the demand is issued.

Providers or suppliers can request extended repayment schedules if experiencing financial hardship. Importantly, CMS will proceed directly to demand the accelerated or advance payments if any of the above eligibility certifications are found to be falsified. After a demand letter requiring repayment is issued, recoupment will continue at 100% until the balance is repaid in full.

Providers and suppliers experiencing cash flow and other challenges as a result of the cyberattack should act quickly.  While there is no specified deadline, CMS will not issue accelerated and advance payments once the disruption to claims servicing is remediated, regardless of when a request is received.  Further, CMS reserves the right to conduct post-payment audits related to any accelerated or advance payments issued under this program.

Our team continues to monitor the impact of the recent cyberattack on healthcare providers and suppliers. If you have questions about CHOPD accelerated or advance payments, including whether your organization may be eligible to apply, or other impacts of the recent events, please contact the authors.