Hello Roberta Buell,

Just in case you thought the Healthcare Universe could not possibly get any crazier, things have recently gone totally sideways. The Change Healthcare (which should be called NO CHANGE) Ransomware attack has reduced payments to a trickle. As an aside, here's something you might want to think about--United Healthcare owns Change Healthcare/Optum. As a result of the hack, the insurance giant is not paying many people. And, we all know some of these claims will be missed altogether. Think they will show a profit? It's quite hard not to be cynical when one company owns just about every healthcare sector. The government tried to step in before this merger took place, but giants have a lot of lobbyists, I guess.

We discuss the origins, results, and possible fixes to the Change Healthcare attack. We will publish a Breaking News if and when there is a widespread fix.

Additionally, we shortened this issue a bit because we certainly know our peeps on the front lines are swamped. But, please peruse the very, very long list of HCPCS changes for this coming quarter. It is so hard to keep up with these codes these days. So, we tried to make your transition to Quarter 2 a little easier. Hospital Outpatient changes are not published yet.

Finally, as you may have heard, the House has passed a bill that adds 1.38% bump to the Physician Fee Schedule. Here's the wacky part--the change is supposed to happen on SATURDAY. That's right--this Saturday. Do the CMS folks or the MACs work on Saturday? That's news to me. Also, the Bill is currently not passed by the Senate or signed by Biden. This is all expected to happen by midnight on Friday. Watch what happens.

I have to say this is one of the craziest time I have been through since the demise of the Sustainable Growth Rate, the most stupendous oxymoron of all time. If you don't know or remember what the SGR was, you didn't miss a thing.

It's 5 o'clock somewhere,

Da' Mistress

On February 21, 2024, the group known as BlackCat shut down Change Healthcare, a division of the nasty healthcare giant, United Healthcare. They requested $22.7 million in bitcoin--a drop in the bucket considering the CEO of United Healthcare made over $20 million in just one year. And, since the attack, chaos has ensued for most practices and hospitals across the U.S. I have heard several ridiculous theories about this, including that United did this on purpose to drive practices broke for eventual acquisition. While I'm pretty sure this is a healthcare myth, the truth may be stranger than fiction. Herein we attempt to tell you the scoop on who did this; why/how it affects HCPs; and, what to do about this .

What Happened

In summary, the criminal hacking group that claimed credit for the crippling ransomware attack on Change Healthcare has shuttered its website, posting an apparently fake law enforcement takedown notice and claiming it would sell its source code. However, the strangest part is--where's the $$? The group, known interchangeably as ALPHV or BlackCat, posted the fake seizure notice some time between late Monday evening and early Tuesday after reports that it had received a ransom payment from Change Healthcare — and then refused to distribute it to the affiliate/cybercriminal/actual hacker that had carried out the attack. Outlaws will be outlaws.

In a post to an underground criminal forum Sunday, a person claiming to be an ALPHV affiliate — a member of a group that carries out ransomware attacks using ALPHV’s tools in exchange for splitting the proceeds of any ransomware payments — claimed that Change Healthcare’s parent company had made a $22 million ransom payment in Bitcoin. However, the cybercriminal who claims to have given BlackCat access to Change’s network says the crime gang cheated them out of their share of the ransom, and that they still have the sensitive data that Change reportedly paid the group to destroy. Meanwhile, the affiliate’s disclosure appears to have prompted BlackCat to cease operations entirely. BlackCat on the flip side states that the FBI seized the money by posting a fictional seizure notice on their web site. This notice is definitely a fake.

Change Healthcare has not answered questions about the whereabouts of $22 million payment. But, my money is on AlphaV who has apparently done this in the past. So, United may have been sort of scammed--boo hoo. Tiny violins playing.

What the Impact is

That's the funnier part of this whole incident--but the results of the hack are definitely not funny. We surveyed practices at our webinar on Tuesday (N=297) and 83% responded that they are feeling the pain of this attack--by the way, we had practices of all specialties with some being part of hospital networks. Here's what is impacted by this craziness:

• 45% said pharmacy operations have been affected
• 82% Said that outgoing have been impacted
• 76% said incoming payment information/adjudications are affected
• 76% said they have received few or no payments
• 66% said they have problems posting charges (that was a surprise)

With Change's networks down, millions of providers are unable to process claims to their payers and , as a result, be reimbursed for services. Pharmacies are unable to fill some prescriptions without taking on financial risk. Hospitals and clinics are forced to cancel treatments and procedures until the issue is resolved. This does not just impact one segment of healthcare--it is massive and large industry groups like the AMA and AHA are up in arms!

What's Being done about The Outage

Meanwhile, the U.S. Department of Health and Human Services said Tuesday it was taking steps to help facilitate payment processing and other financial support measures to support health care providers, many of whom are facing cash flow problems amid the ongoing ransomware attack. Here are the steps that CMS and HHS are taking in the short term. Notice that they are not offering financial help as they did during the pandemic:

• Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.
• CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack. Don't hold your breath for that one
• CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State. "Strongly encourages" does not mean that this is an order.
• If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.
• CMS has contacted all of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While CMS recognizes that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method. We have heard that some Macs are not accepting paper claims as yet.

We believe the best source of information for your individual claim and payment path is to check with your vendors. Many practice management/ Patient Accounting systems are trying to change their clearinghouses and/or Electronic Data interchange. We strongly encourage you to talk to your own vendor. Why? You must attest or sign off on many of these changes and YOU don't want to be standing in the way of their progress.

You can also see the Change/Optum/United updates here--but be forewarned that this information is like asking Bagdad Bob or Tokyo Rose for real news. For example, they say that there is 90% claim flow, which is dubious. The best thing they state on the web site is that they claim to offer funding for hurting providers. According to the web site, to access the temporary funding assistance program, please visit www.optum.com/temporaryfunding.

This quarter we had almost as many deletes as ADDS so I included them which I do not usually do. Please also check out the descriptor changes included herein. For more details on the Quarterly update, click right here. Add means new codes; discontinued means deleted 4/1/2024, and changed means, well, you know.

HCPC ACTION CD LONG DESCRIPTION

G0138 ADD Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga

J0177 ADD Injection, aflibercept hd, 1 mg

J0209 ADD Injection, sodium thiosulfate (hope), 100 mg

J0577 ADD Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy

J0578 ADD Injection, buprenorphine extended-release (brixadi), greater than 7 days and up to 28 days of therapy

J0589 ADD Injection, daxibotulinumtoxina-lanm, 1 unit

J0650 ADD Injection, levothyroxine sodium, not otherwise specified, 10 mcg

J0651 ADD Injection, levothyroxine sodium (fresenius kabi) not therapeutically equivalent to j0650, 10 mcg

J0652 ADD Injection, levothyroxine sodium (hikma) not therapeutically equivalent to j0650, 10 mcg

J1010 ADD Injection, methylprednisolone acetate, 1 mg

J1202 ADD Miglustat, oral, 65 mg

J1203 ADD Injection, cipaglucosidase alfa-atga, 5 mg

J1323 ADD Injection, elranatamab-bcmm, 1 mg

J1434 ADD Injection, fosaprepitant (focinvez), 1 mg

J2277 ADD Injection, motixafortide, 0.25 mg

J2782 ADD Injection, avacincaptad pegol, 0.1 mg

J2801 ADD Injection, risperidone (rykindo), 0.5 mg

J2919 ADD Injection, methylprednisolone sodium succinate, 5 mg

J3055 ADD Injection, talquetamab-tgvs, 0.25 mg

J3424 ADD Injection, hydroxocobalamin, intravenous, 25 mg

J7165 ADD Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity

J7354 ADD Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)

J9073 ADD Injection, cyclophosphamide (ingenus), 5 mg

J9074 ADD Injection, cyclophosphamide (sandoz), 5 mg

J9075 ADD Injection, cyclophosphamide, not otherwise specified, 5 mg

J9248 ADD Injection, melphalan (hepzato), 1 mg

J9249 ADD Injection, melphalan (apotex), 1 mg

J9376 ADD Injection, pozelimab-bbfg, 1 mg

Q5133 ADD Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg

Q5134 ADD Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg

C9159 Discontinued Injection, prothrombin complex concentrate (human), balfaxar, per i.u. of factor ix activity

C9160 Discontinued Injection, daxibotulinumtoxina-lanm, 1 unit

C9161 Discontinued Injection, aflibercept hd, 1 mg

C9162 Discontinued Injection, avacincaptad pegol, 0.1 mg

C9163 Discontinued Injection, talquetamab-tgvs, 0.25 mg

C9164 Discontinued Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)

C9165 Discontinued Injection, elranatamab-bcmm, 1 mg

J0576 Discontinued Injection, buprenorphine extended-release (brixadi), 1 mg

J1020 Discontinued Injection, methylprednisolone acetate, 20 mg

J1030 Discontinued Injection, methylprednisolone acetate, 40 mg

J1040 Discontinued Injection, methylprednisolone acetate, 80 mg

J1840 Discontinued Injection, kanamycin sulfate, up to 500 mg

J1850 Discontinued Injection, kanamycin sulfate, up to 75 mg

J2920 Discontinued Injection, methylprednisolone sodium succinate, up to 40 mg

J2930 Discontinued Injection, methylprednisolone sodium succinate, up to 125 mg

J9070 Discontinued Cyclophosphamide, 100 mg

J9250 Discontinued Methotrexate sodium, 5 mg

Q4244 Discontinued Procenta, per 200 mg

J0208 Description Chg Injection, sodium thiosulfate (pedmark), 100 mg

J0612 Description Chg Injection, calcium gluconate, not otherwise specified, 10 mg

J0613 Description Chg Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg

J3380 Description Chg Injection, vedolizumab, intravenous, 1 mg

J3425 Description Chg Injection, hydroxocobalamin, intramuscular, 10 mcg

J7516 Description Chg Injection, cyclosporine, 250 mg

J9029 Description Chg Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose

J9260 Description Chg Injection, methotrexate sodium, 50 mg

Also, there was a note for J9071 Cyclophosphamide 5 mg (Auromedics) and J9072 Cyclophosphamide 5 mg (Dr. Reddy's) that they have coverage and long descriptor change. I cannot see what the description change is and it is not obvious what the coverage change is. Check with your MAC's web site around April 1.

The House on Wednesday passed a $460 billion spending bill to avert a partial government shutdown. The spending package includes provisions that are critical to hospitals and physicians.

House lawmakers approved the measure by a 339-to-85 vote, The Senate was expected to take up and pass the bill easily, sending it to President Biden in time for it to become law before a midnight deadline on Friday, various reports have confirmed.

To summarize, the bipartisan spending bill, which was unveiled on Sunday, reduces some of this year’s cuts to physician Medicare pay, pushes back scheduled disproportionate share hospital (DSH) payment cuts and increases annual funding for community health centers.

The 1,050-page bill (PDF) outlines the funding for several federal agencies, including the Food and Drug Administration and the Department of Veterans Affairs. A second set of bills would be needed before a March 22 cutoff to fund other portions of the government, including the Department of Health and Human Services. Here are some details for those of us who need to know

• The Bill blunts the doctor pay decrease enacted in the 2024 Medicare Physician Fee Schedule final rule by providing a 1.68% fee schedule bump that, alongside an earlier increase from the end of 2023, totals a 2.93% payment increase that will run through the end of the year—still below the 3.37% decrease of the final rule. Allegedly, this will be enacted on March 9 on a prospective basis. But, how can it be enacted what with all the chaos from the Change Healthcare/United debacle????
• An $8 billion-per-year cut to Medicaid DSH program payments that has been repeatedly punted by lawmakers would again be pushed back, this time to January 1, 2025.
• The hospital sector also will see better payments from extensions of the higher inpatient payment adjustment for low-volume hospitals and the Medicare-dependent ("High Medicare") Hospitals.
• Also included in the legislation is $270 million in new annual funding for community health centers. That money is backdated to the beginning of the current fiscal year (October 1) and brings the centers’ total funding to $4.27 billion annually.
• Elsewhere in the bill is a one-year extension to incentive payments for participation in certain alternative payment models ("APMs"), although the incentive has been reduced from a 3.5% bonus to a 1.88% bonus--I guess it's better than nothing.
• Lawmakers also extended through December 31 funding for the National Health Service Corps with an additional $35 million, the Teaching Health Center Graduate Medical Education program with a $48.5 million increase and funding for the Special Diabetes Programs with a $10 million increase.
• Last but not least for physician offices is the reinstatement of the GPCI floor of 1.00 for Work Relative Values until January 1, 2025. This has bounced around for so many years. I was probably a child when the Floor was first threatened.

The Senate is supposed to pass the Bill for President Biden's signature on or before March 8th at midnight--watch and wait.

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