10/01/2025

CMS Releases Statement Regarding Services During Shutdown

Update on Medicare Operations: Telehealth, Claims Processing, and Medicare Administrative Contractors Status During the Shutdown

Published by MLN Connects 10/01/2025

When certain legislative payment provisions (“extenders”) are scheduled to expire, CMS directs all Medicare Administrative Contractors (MACs) to implement a temporary claims hold. This standard practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements. The hold prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date and should have a minimal impact on providers due to the 14-day payment floor. Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted.

Absent Congressional action, beginning October 1, 2025, many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency will take effect again for services that are not behavioral and mental health services. 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. In some cases, these restrictions can impact requirements for meeting continued eligibility for other Medicare benefits. 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. Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are not payable by Medicare in the absence of Congressional action. Additionally, Medicare would not be able to pay some kinds of practitioners for telehealth services. For further information: https://www.cms.gov/medicare/coverage/telehealth.

CMS notes that the Bipartisan Budget Act of 2018 allows clinicians in applicable Medicare Shared Savings Program

Accountable Care Organizations (ACOs) to provide and receive payment for covered telehealth services to certain Medicare beneficiaries without geographic restriction and in the beneficiary’s home. There is no special application or approval process for applicable ACOs or their ACO participants or ACO providers/suppliers. Clinicians in applicable ACOs can provide these covered telehealth services and bill Medicare for the telehealth services that are permissible under Medicare rules during CY 2025, irrespective of further Congressional action. For more information:

https://www.cms.gov/files/document/shared-savings-program-telehealth-fact-sheet.pdf.

MACs will continue to perform all functions related to Medicare Fee-for-Service claims processing and payment.

Join Us October 8-9 at The Grand Event Center in Columbus

The Ohio Association of Medical Equipment Services invites you to register for the association’s premier event of the year that brings together Ohio’s HME professionals, leading manufacturers, service vendors, managed care organizations and industry experts, for two jam-packed days of top tier learning and invaluable networking!  

Join us October 8-9 in Columbus for OAMES 44th Annual Meeting & Exhibition, “Rooted in Care - Growing the DME Community Together,” highlighting the tenacity of Ohio’s HME providers and their dedication to industry solidarity for everyone's future!  You’ll find event details in the OAMES 2025 Annual Meeting Flyer  and schedule at a glance  with secure online registration link available here . 

Register and book your room! 

• Registration – Sign up today using OAMES secure online system or if you prefer, you can download the hard copy registration form  and fax or email to OAMES. Early-bird discount registration rates expire 10/3/2025!
• Accommodations – Our hotel is full, but the following properties are close to The Grand Event Center: 

Courtyard Columbus Downtown
35 W. Spring Street
Columbus, OH 43215
Telephone: +1-614-228-3200

Aloft Columbus University District
1295 Olentangy River Road
Columbus, Ohio, USA, 43212
Telephone: +1 614-294-7500

Not a member?  Check out OAMES "Regular" (provider) and "Associate" (vendor) membership rates and benefits here.