Claims for telehealth services provided to patients in their homes and outside of rural areas are among the claims for services that still face a payment pause.
The Centers for Medicare & Medicaid Services (CMS) says the agency will continue to pay most Medicare claims on a timely basis, reversing an earlier notice that there would be a broad pause on payment claims due to the federal government shutdown.
In the earlier notice, CMS told Medicare Administrative Contractors to hold claims with a service date of Oct. 1 and later for services impacted by the expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act of 2025. These services included payments under the Medicare Physician Fee Schedule and federally qualified health center claims.
In an update on service claim payments released on Oct. 15, CMS clarified that most claims will be paid on a timely basis.
"In light of the continuing government shutdown, CMS will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions," the claims payment update says. "To date, no payments have been delayed as statute already requires all claims to be held for a minimum of fourteen days, and this recent hold is consistent with that statutory requirement."
Claims for some telehealth services are among the claims that will be impacted by the expired provisions, according to CMS.
"Absent Congressional action, beginning Oct. 1, 2025, many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency took effect again for services that are not behavioral health services," the claims payment update says. "These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas, and hospice recertifications that require a face-to-face encounter."
CMOs, CFOs, and other healthcare provider leaders should monitor legislative action in Congress that could affect payment for telehealth services, according to CMS. Until Congress acts on expired telehealth payment provisions, healthcare providers should consider holding claims for telehealth services that are not payable by Medicare, CMS says.
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
CMS had said there would be a payment pause for many claims during the federal government shutdown, including payments under the Medicare Physician Fee Schedule and federally qualified health center claims.
In a claims payment update issued Oct. 15, CMS clarified that most claims will be paid in a timely manner, with the exception of claims for services impacted by expired Medicare legislative payment provisions such as telehealth visits in patients' homes.