Government Says Medicare Payments to Doctors Will Not Be Delayed

The Centers for Medicare and Medicaid Services initially said claims from Oct. 1 would be held.

This file photo shows a federal Medicare office. Spencer Platt/Getty Images

The Centers for Medicare and Medicaid Services (CMS) said on Oct. 15 that most Medicare claims would be processed and paid “in a timely manner.”

“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,” CMS stated on its website.

“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. Providers may continue to submit claims accordingly.”

The expired provisions include one funding a program called Acute Hospital Care at Home that enabled organizations to provide hospital care at the homes of Medicare beneficiaries.

The provisions expired when the government shut down on Oct. 1. Lawmakers have not yet reached an agreement on reopening the government.

CMS had said earlier on Oct. 15 in a newsletter that it had instructed Medicare administrative contractors to temporarily hold claims from Oct. 1, including all claims paid to doctors under the Medicare Physician Fee Schedule and ground ambulance transportation claims.

“Providers may continue to submit these claims, but payment will not be released until the hold is lifted,” CMS stated in the newsletter.

A CMS spokesperson declined to comment on the change, beyond saying that the update issued later on Oct. 15 contains the most up-to-date information.

In the update, CMS also said that without congressional action, many legal limitations in place for telehealth services have taken effect again. Special rules for the services were put into place during the COVID-19 pandemic and have been extended.

“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,” CMS stated. “In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.”

That form is issued by doctors and other providers to Medicare beneficiaries to alert them when Medicare payments are expected to be denied.

If the government does not include funding for the programs and make them retroactive to the start of the shutdown, administrators will deny claims, the American Medical Association stated. In that scenario, doctors would be able to directly charge patients who signed the notices of noncoverage.

Some institutions have informed patients with Medicare that they will not be providing telehealth services because of the shutdown.

“Medicare and Medicaid patients are unable to schedule new telehealth/video visits,” NYU Langone Health in New York City stated on its website. “If you already have a visit scheduled, it will continue as planned. If not, contact your doctor’s office to schedule an in-person appointment.”