Medicare lifts hold on claim processing amid government shutdown
Medicare has lifted a temporary hold on claim processing amid the ongoing federal government shutdown.
The federal healthcare program for seniors originally implemented a 10-day pause on payments, with 53% of Centers for Medicare & Medicaid Services staff retained during the political stalemate that started Oct. 1. After the shutdown entered its third week, however, CMS said it would continue holding payments for physicians, a move that drew backlash from radiologists and other physicians.
Medicare backtracked after announcing the decision, saying the hold only would apply to select claims paid under the Medicare Physician Fee Schedule, which are affected by expired provisions, such as Geographic Practice Cost Indices. But CMS announced Oct. 21 it has instructed all Medicare Administrative Contractors to lift the hold and begin processing claims dated Oct. 1 and later. This includes those paid under the physician fee schedule, ground ambulance transport, and bills related to Federally Qualified Health Centers.
“CMS has directed all MACs to continue to temporarily hold claims for other telehealth services (i.e., those that CMS cannot confirm are definitively for behavioral and mental health services) and for acute Hospital Care at Home claims,” the notice reads.
The American College of Radiology highlighted the announcement in a news post shared Oct. 21, noting that the change also applies to telehealth claims CMS can confirm are definitively for behavioral and mental health services. ACR said it’s unclear how the agency intends to address claims impacted by the expiration of the 1.0 Geographic Practice Cost Index floor, applied to physician work in 39 states and territories around the country.
Telehealth services are now limited to rural areas, as was the case before the COVID-19 pandemic, ACR added. Patients cannot receive telehealth services in their homes, and the ability to provide audio-only services to Medicare beneficiaries and Acute Hospital Care at Home participants also have lapsed. However, interpretation of imaging studies performed via teleradiology are not impacted.
“ACR continues to closely monitor this extremely fluid situation,” the college noted in its update.
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.