When the clearinghouse went dark

In February 2024, Change Healthcare, one of the largest claims clearinghouses in the United States, was hit by a ransomware attack and took its systems offline. For practices that sent their claims through it, the effect was simple: claims stopped going out, remittances stopped coming in and cash stopped arriving.

The American Medical Association surveyed physicians in the weeks that followed. Eighty percent of practices said they had lost revenue from unpaid claims, 85% had put extra staff time into revenue cycle work, and more than half had used personal funds to cover practice expenses. Most respondents were in practices of ten physicians or fewer.

The single point of failure

Most practices connect to payers through one clearinghouse and rarely think about it. It sits between the practice management system and hundreds of payers, sending claims out and bringing remittances back. When it stops, eligibility checks, claim submission and electronic remittance advice stop with it. In the AMA's follow-up survey in late April 2024, 79% of practices still could not receive electronic remittance advice.

A contingency plan on one page

1. Know how to switch. Find out now what it takes to connect a second clearinghouse, how long enrollment takes and whether your practice management system supports it.
2. Enroll in your largest payers' portals. Most accept direct claim entry and show claim status, and enrollment takes days you will not have during an outage.
3. Keep ERA and EFT records by payer, so you know who sends your remittances and how to redirect them.
4. Know how many weeks of expenses you could cover if payments stopped, and decide in advance how you would bridge the gap.
5. Read your vendor agreements. They should say how you will be told about an incident and what happens to your data.

Why this is a billing question

Cybersecurity usually lands with IT, but the consequences land with billing. Whoever runs your revenue cycle should know, before anything happens, which claims can go out another way and in what order.