Medicare halts claim processing, posing serious financial risk to radiology practices
UPDATED Oct. 16 at 8:30 a.m. Central Time: Medicare on Wednesday said it’s pausing the processing of certain claims amid the government shutdown, a move experts say could cripple independent imaging groups.
The federal healthcare program for seniors originally implemented a 10-day hold on payments, with 53% of Centers for Medicare & Medicaid Services (CMS) staff retained amid the political stalemate. However, as the shutdown enters its third week—with no formal congressional negotiations occurring—Medicare said it will continue its temporary hold on payments.
On Wednesday, the Radiology Business Management Association—which represents over 2,200 leaders across 800 imaging groups—said the pause poses “serious financial risks to physician practices across the country.” It urged CMS to immediately resume claim processing, hoping to ensure “continuity of care and preserve the financial viability of the healthcare system.”
“For radiology groups, where Medicare beneficiaries often comprise 30% or more of the patient mix, this delay in reimbursement threatens operational stability,” Linda Wilgus, MBA, co-executive director of the RBMA and a former radiology practice executive director, told Radiology Business. “Most practices operate with only 30 to 60 days of cash on hand, leaving them vulnerable to even short-term disruptions.”
CMS on Wednesday urged physicians who perform telehealth services that are not payable after Oct. 1 to consider sending beneficiaries an advanced notice of noncoverage. The agency said the pause impacts select claims paid under the Medicare Physician Fee Schedule—which are affected by expired provisions, such as Geographic Practice Cost Indices— along with those related to ground ambulance transport and Federally Qualified Health Centers. CMS indicated providers can continue to submit claims, with those not affected by expired provisions expected to be processed and paid as they pass the statutorily required, 14-day payment floor.
The American College of Radiology—representing over 40,000 imaging professionals—also highlighted the claims pause in a blog post Wednesday (which it later updated Thursday morning). ACR said it continues to monitor the government shutdown and will post updates on its website. The college noted that Democrats are pushing to extend insurance premium tax credits established under the Affordable Care Act, which expire in 2026. Failing to remedy this will result in healthcare costs increasing for those who buy health plans on insurance exchanges. Republicans, meanwhile, want a budget resolution that’s free of any unrelated policies they believe should be discussed separately.
Congress has held multiple votes and negotiations since the shutdown started Oct. 1, with no compromise reached, ACR noted. The Senate held its eighth vote on a House-passed budget resolution Oct. 14 but fell short of the 60 votes required to advance the continuing resolution, the American Hospital Association reported.
Editor's note: This story was updated Oct. 16 after CMS modified its web page, which ACR reflected in its blog post. The updates are reflected in bold.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.