The Change HealthCare hack

This post uses material that a Facebook friend posted. I re-post it here with her permission.

Any provider that uses a Billing Software (that has Change HealthCare integrated in their system as the main clearinghouse) can’t get claims to insurance companies once they medically bill for something/services in their software. Change Healthcare is the ‘bridge’. The claim goes from the provider, over the bridge, to the insurance company. Then once the claim and payment process, it comes back over the bridge and dumps into the software.

The bridge has been blown up.

Aside from not being able to get stuff over, there is a lot of money and explanation of payment/benefits that aren’t coming into the Billing Software from previous cut-off/adjudication cycles.. Without the bridge, providers are scrambling to make their own bridges, called “Work Arounds”. Depending on what branch of healthcare, these generally are extremely time consuming and there isn’t enough meticulous manpower to keep up with everything. Meantime money is being pumped out for cost of overhead, without money coming in to meet profit margins. This can ultimately lead to the Provider closing its doors. That means hospitals aren’t getting paid for office visits, labs, radiological services, surgeries, literally everything they are capable of doing. Physical Therapist aren’t getting paid for Therapy. Optometrist can’t get paid for eye visits or glasses/lenses. DME can’t get paid for oxygen/wound care/beds/Wheelchairs/Power Wheelchairs. The list goes on and on.”

In addition to this, Change Healthcare spent years acquiring and consolidating smaller clearinghouses and other administrative entities, such as RelayHealth, meaning that this one company now has its tentacles in a staggering amount of transactions throughout the healthcare industry. Change itself is now owned by Optum/United Health Group, which has in turn been consolidating even more aggressively through essentially simultaneous vertical and horizontal integration.
There are other clearinghouse vendors that perform the same functions, but many provider-facing software systems lock themselves into integration partnerships with a single clearinghouse, leaving very few options when that single bridge gets blown up. And even if the provider uses a different clearinghouse, as stated above, Change may be involved somewhere else down the chain that the provider is not even aware of.

The automated functions that the clearinghouse performs have replaced a lot of transaction-based human labor in the industry over the last 15-20 years, so when the automations break….there is no redundancy or surge capacity on either side of the bridge to make up for it. Many current employees don’t even know how to do some of these tasks manually, and certainly not with any sort of efficiency/scale.
As we learned with many things during COVID (ex. supply chain), maximizing for profit and efficiency makes for very fragile systems. I would hope that we will learn from this as a society and crack down on this kind of monopolization for critical infrastructure, but I fear that we won’t learn a damn thing. It’s tough to watch.”
Too big to fail.. should be too big to exist.. the Government failed us..