The Change Healthcare cyber-attack is having a significant impact on the ability of home infusion pharmacies to verify patient eligibility, benefits and out-of-pocket responsibility, as well as transmit claims and receive remittance and payment. At the time of this publication, NHIA estimates that the majority of infusion pharmacies are unable to transmit a significant portion of their medical and pharmacy claims. Despite provider and payor efforts to develop workarounds to facilitate the transmission of information and claims, this disruption is causing major reductions in cash flow, making it increasingly difficult for some providers to serve patients, particularly those needing high-dollar specialty infusions.
NHIA offers recommended actions for payors to consider to ensure the continuity of care for all patients throughout the duration of the disruption.
NHIA has developed recommendations for commercial, Medicaid and Medicare Advantage payors to reduce administrative burden and remove barriers to accessing certain infusion services.
Designed to be incorporated into contracts between health plans and home and alternate site infusion providers, the recommendations deal with issues such as specialty networks for certain drugs; coordinating the provision of drug, supplies and services; covering preventative services; streamline authorization procedures; and more. Each recommendation includes a detailed rationale and proposed metrics to promote data collection by providers as a means of assessing the success of these proposed policy changes.
By removing barriers to outpatient infusion services, payors can reduce the total cost of care by avoiding hospital stays and emergency room visits, limiting hospital outpatient department use, and preventing admission to long-term care facilities.
The National Home Infusion Association (NHIA) has developed recommendations for commercial, Medicaid, and Medicare Advantage payors to improve patient outcomes and experience, reduce administrative burden, and improve timely access to home infusion services.
The National Home Infusion Association (NHIA) is pleased to hold its second annual one-day Payor Summit. The event, designed to bring together representatives from commercial health insurance plans with home and specialty infusion leaders, will
The National Home Infusion Association (NHIA) is pleased to announce that it successfully petitioned the Centers for Medicare and Medicaid Services (CMS) to secure a new billing code for injectable immunotherapies and revise an existing
The National Home Infusion Association (NHIA) has prepared a white paper summarizing the impact of cost increases incurred by infusion providers due to pandemic-related supply shortages with a particular focus on parenteral nutrition (PN) components
