Other clearinghouses, cash-pay patients, insulate reproductive medicine sector from severe financial crunch.
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BY RON SHINKMAN
A ransomware breach of one of the nation’s largest clearinghouses for health insurance claims has likely caused some consternation to reproductive medicine practices, an expert familiar with the situation says.
The breach of Change Healthcare – a subsidiary of UnitedHealth Group, the nation’s largest medical insurer – occurred in late February. Change reportedly paid a $22 million ransom in bitcoin to regain control of its data and networks, but the company said it will not be able to start processing healthcare claims against until at least March 18. Change handles about 15 billion healthcare transactions a year, according to the U.S. Department of Health and Human Services.
“The hack affected not only (our customers), but the entire healthcare industry,” said Nimesh Shah, chief executive officer of eIVF, which provides services to about 140 fertility practices, although not all of them use its billing service. The company relies on Change Healthcare to process and pay claims to its clients. Shah said about 30 to 40% of the claims its processes for clinics are billable to insurance companies, and the company typically handles “thousands” of such claims each day.
The issue has become so serious that last Sunday, Health and Human Services (HHS) issued a letter urging UnitedHealth to “take responsibility to ensure no provider is compromised by their cash flow challenges stemming from this cyberattack” and “ensure expedited delivery of funds to impacted providers.”
How the breach is impacting individual reproductive medicine clinics and their networks remains unclear. Executives and spokespersons with some of the largest fertility clinics in the U.S. – including Boston IVF, Shady Grove, the Prelude Network, Progyny and the University of California at San Francisco Center for Reproductive Health – have either declined to comment or did not immediately respond to requests seeking comment.
Taylor Stein, co-CEO of EngagedMD, which provides support services to clinics but does not handle their claims, suggested that fertility centers’ finances may not be as crimped as other medical practices, because of the number of self-pay IVF patients.
“Unless they’re operating in states (with mandated insurance coverage for IVF), most clinics have a lot of cash coming in the door,” Stein said.
Workarounds through other clearing houses
Meanwhile, other clearinghouses have been offering workarounds to providers who contract with Change Healthcare. Availity, another claims clearinghouse, is offering to process claims for Change clients, Shah said.
“Once a clinic registers with Availity and creates a relationship, we’re automating that into our (electronic medical records) or billing solution, so that they can do things in an automated fashion as opposed to a manual process (for submitting claims),” Shah said. He added that about half of eIVF’s clients – fewer than 100 in total – have signed onto the program, which is known as Availity Lifeline.
According to Availity spokesperson Matt Schlossberg, the company has "provided free digital connectivity to more than 300,000 providers—and that number continues to grow,” Schlossberg said in an email, adding that about $5 billion worth of claims had been processed through the program as of early this week. He was unable to immediately provide a breakdown on the number of reproductive medicine providers participating in the program.
Remaining concerns
Although Shah observed that his company wants “to create choice whenever possible,” he would not say directly whether eIVF would seek another clearinghouse for its clients.
“When this happens, nobody is claiming victory,” he said. "If you’re Availity or (other clearinghouses), you are not excited by what just happened. Probably their number one reaction is ‘thank God that wasn’t us.’”
However, the likelihood of clearinghouses and other players in the healthcare industry dodging such breaches appears to be diminishing, said Stein, whose expertise is in cybersecurity.
“They’re going to keep on happening,” he said. “It’s the new normal.”
The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.
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