Tag: UnitedHealthcare (UHC)
UHC Network News July 1, 2024
Take Note: Quarterly CPT and HCPCS Code Updates
Effective Jul. 1, 2024, all applicable Medical Policies and Medical Benefit Drug Policies have been updated to reflect the quarterly Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) code additions, revisions, and deletions. Refer to the following sources for information on the code updates:
G-Code Frustration
Deepening ongoing physician concerns over the implementation of Medicare’s add-on code for complex care, two major payers have either reduced payment for G2211 claims or announced plans to stop paying certain claims associated with the code altogether for particular plan members.
UHC Responsible for Breach Notifications
The Health and Human Services (HHS) Department announced Friday (May 31, 2024), United HealthCare must take responsibility for informing people about privacy breaches resulting for the the Change Healthcare cyberattack.
UnitedHealth Group previously disclosed that the ransomware attack exposed personal information of a “substantial portion” of Americans.
That “substantial portion” turns out to be 1 in 3 Americans.
“OCR must affirm its position that the breach was perpetrated upon Change Healthcare, whose status as a healthcare clearinghouse makes them a covered entity under HIPAA and thus responsible for the breach of any [protected health information] which it processes or facilitates the processing of,”
Under HIPAA, UnitedHealth Group must provide affected individuals with descriptions of the incident, what data were compromised, how the company responded to the attack, how the company can be reached and what individuals can do to protect themselves.
Virtual Vigilance
“The Change outage was disruptive to the business of my practice, but most importantly it was disruptive to my patients,” Dr. Bruggeman testified. “Every minute my staff spent trying to reconcile [electronic remittance advice] with received payments, assessing which patients received incorrect bills, [and] resubmitting prior authorizations is time taken away from patient care.”
Robust Cybersecurity Can Safeguard Practices
By Alisa Pierce Texas Medicine June 2024
Data held hostage
. . . cautions that ransomware attacks can be delivered via multiple platforms, such as in email attachments or links within an email. Malicious attachments can include documents, zip files, and executable applications, and suspicious email links can bring users directly to websites that are used to place malware on a system.
Similarly, “phishing” email scams can give hackers access to internal business systems that could reveal confidential information like credit card numbers, personal identity data, and passwords. Often these emails appear to come from real companies or trusted individuals.
From there, hackers steal electronic patient data, even encrypted information; block the practice from accessing it; and demand a ransom for its return, much like “a hostage situation,” according to Shannon Vogel, TMA’s associate vice president of health information technology.
If that data aren’t backed up, practices don’t have much leeway. At that point, they can either hope the data can be retrieved by law enforcement or move forward without patient records.
“It’s vital that practices talk to their [electronic health record] and other vendors about redundant systems so that all is not lost,” Ms. Vogel said. “Otherwise, it would be like starting from scratch.”
UHC Notably Absent from Congressional Hearing
Quotes from Texas Medicine 4/19/2024, Emma Freer Article
“The attack has exposed the vulnerability in our health care system and the disproportionate burden placed on physician practices by insurers, government payers, and third-party vendors,” Dr. Bruggeman told lawmakers.
“The Change outage was disruptive to the business of my practice, but most importantly it was disruptive to my patients,” he said. “Every minute my staff spent trying to reconcile [electronic remittance advice] with received payments, assessing which patients received incorrect bills, [and] resubmitting prior authorizations is time taken away from patient care.”
“To add insult to injury, some of these practices were purchased by Optum during the crisis,” he said. “There were even reports of Optum using the financial emergency caused by the cyberattack on its own subsidiary as legal justification to expedite its acquisition of physician practices.”
In the meantime, Dr. Bruggeman called on Congress to pass legislation that would insulate physician practices from industry consolidation and other existential threats.
“Allowing physicians to practice in the setting that is best for them, their patients, and the broader community should be the hallmark of our United States health care system,” he said. “Instead, the increase in administrative burden, including the new threat of potential cyberattacks, makes such events catastrophic for many providers.”
For the full very interesting article: https://www.texmed.org/TexasMedicineDetail.aspx?id=64062&utm_campaign=TMT&utm_medium=email&_hsenc=p2ANqtz-9E4jpFAqBr1fYThi6pjc3ECIrkJtF4-urerPcLF78JmZ4BixUPkxoA-ngiRvbPx06ORd5U2bsbiOEFK-CaqUP6-URb8jMZ6SEHyZL-aPXwfFmCQ9w&_hsmi=303492305&utm_content=303492305&utm_source=hs_email
Change Healthcare Update
In its latest update on the response to the cyberattack on Change Healthcare, UnitedHealth Group said that its largest clearinghouse, called Relay Exchange, will be back online by the end of the weekend and the company will begin processing $14 billion in medical claims.
“Once a critical mass of payer connectivity has been established, we will turn on claims processing for Assurance customers. That process will occur automatically for those Assurance customers when we trigger restart,” UnitedHealth said in its update. “Following activation of Assurance software customers, we will turn our attention to the reactivation of all other Relay Exchange claims submitters. Throughout the reactivation of these provider customer groups, we will continue to add additional payer connectivity to close any remaining gaps. We will start immediately with establishing payer connectivity so claims entering the clearinghouse have a destination.”
The company is targeting the week of April 1 to restore its clinical exchange service, payer connectivity and hosted payer services.
The following week, April 8, the company plans to restore its Risk Manager and Health QX products.
Change to Release Medical Claims Software
On March 18th UnitedHealth Group said they had begin to release medical claims preparation software, a move it says is a critical step in restoring services.
The software will be rolled out to thousands of customers in the next several days, according to the announcement. UHG said that it intends to have third-party attestations available before services are fully online.
Change Healthcare’s electronic payments platform was brought back online as of March 15, and UHG is now “proceeding with payer implementations.
The insurer has also suspended prior authorizations for outpatient care, and is reviewing similar steps for inpatient admissions in Medicare Advantage
Optum Temporary Funding Assistance
The Temporary Funding Assistance Program is designed to help bridge the gap in short-term cash flow needs for providers impacted by the disruption of Change Healthcare’s services.
Eligible providers:
- Providers who receive payments from payers that are processed by Change Healthcare.
- UnitedHealthcare medical, dental and vision providers.
- Providers who have exhausted all available connection options or may be in the process of implementing technical workaround solutions and who work with a payer who has opted not to advance funds to providers during the period when Change Healthcare systems remain down
For questions contact (877) 702-3253
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