On October 21, the Centers for Medicare & Medicaid Services (CMS) directed all Medicare Administrative Contractors (MACs) to lift their temporary hold and begin processing certain claims dated October 1 and later. The announcement provides partial relief to healthcare providers affected by delayed reimbursements during the ongoing federal government shutdown, which is now approaching its fourth week.
What’s Changing
CMS has instructed MACs to resume processing for:
- Medicare Physician Fee Schedule (MPFS) claims
- Ground ambulance transport claims
- Federally Qualified Health Center (FQHC) claims
- Telehealth claims for behavioral health services
These claim types can now move forward for payment, ensuring some revenue flow resumes for affected providers. However, CMS has ordered MACs to continue holding claims for other telehealth services and acute Hospital Care at Home programs, citing the need for further review and operational guidance before those payments can be released.
Why This Matters For Providers
The temporary claim holds have disrupted revenue cycles for many physician practices, hospitals and community health centers that rely heavily on Medicare reimbursements. Even brief interruptions in payment processing can create cash flow challenges, increase administrative burden and delay patient account resolution.
The selective lifting of holds signals CMS’s effort to balance operational continuity with the complexities of managing certain telehealth and at-home care services under current funding constraints. Providers will need to closely monitor communications from their MACs to understand which claims are now moving forward and which remain paused.
What Should Healthcare Organizations Do?
Healthcare leaders and billing departments should:
- Review all claims held from October 1 onward to determine which can now be resubmitted or tracked for processing.
- Stay updated on MAC and CMS notifications for additional telehealth and Hospital Care at Home claim guidance.
- Assess revenue cycle impact and adjust cash flow forecasts accordingly.
- Ensure documentation and coding accuracy, particularly for behavioral health telehealth services, which are being prioritized for payment.
- If your organization is facing uncertainty due to CMS claim holds or reimbursement changes, now is the time to strengthen your revenue cycle strategies and prepare for continued adjustments in federal policy.
How We Can Help?
Our healthcare consultants guide organizations through CMS changes, reimbursement challenges and regulatory uncertainty. During the current shutdown, we help providers:
- Interpret new CMS directives to prevent compliance issues and payment delays.
- Review and reconcile held claims for accurate resubmission.
- Streamline revenue cycle workflows to improve efficiency and reduce denials.
- Train staff on updated billing and documentation requirements.
We assist your organization in staying informed, compliant and financially stable, no matter how regulations evolve. For questions or more information, contact your Windham Brannon advisor today, or reach out to Denise Gaulin.
