Restoring Billing Operations After a Cyber Attack for a Multi-Specialty Practice

Client Overview:

In February 2024, a cyber attack on Change Healthcare significantly impacted the billing operations of a multi-specialty practice. The in-house billing team faced numerous challenges, including difficulties in submitting claims electronically and delays caused by a manual payment posting process. These issues led to a substantial decline in revenue and overwhelmed the staff.

Challenge

The multi-specialty practice experienced severe disruptions due to the cyber attack:

Solution

To address the crisis, we implemented a strategic and systematic approach:

Comprehensive Portal Strategy:

Our team of seasoned billers, well-versed in urgent care billing and COVID-19 guidelines, took charge of the claims process. Their expertise ensured accurate coding and faster claim resolutions.

Optimized Submission Processes:

Our analysis revealed that most insurers used Availity Essentials, while Medicare and Medicaid required submissions via NGS Connex and ePaces, respectively. This insight allowed us to streamline the submission process for each claim type.

Expert Team for Manual Submissions:

With a monthly volume exceeding 6,000 claims, our skilled team of expert billers efficiently managed manual submissions, ensuring that claims were processed without unnecessary delays.

Insurance Verification Specialists:

We deployed a dedicated team of insurance verification specialists who ensured accurate eligibility checks before claim submissions. This proactive measure reduced errors and improved claim acceptance rates.

Payment Tracking and Posting:

We diligently tracked payment remittances to ensure timely and accurate payment postings. This step was critical in maintaining financial stability despite the clearinghouse disruption.

Results

Our efforts restored a steady cash flow within just two months, even with the dysfunctional clearinghouse. Payment posting was up-to-date, and the client experienced significant operational relief.