When the federal government shutdown began on October 1, 2025, the U.S. Centers for Medicare and Medicaid Services (CMS) directed all Medicare Administrative Contractors (MAC) to implement a temporary claims hold of up to 10 business days to ensure that Medicare payments would be accurate and consistent with statutory requirements. CMS has now revised its instructions to limit the claims hold only to those “services impacted by the expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025."
Rebecca Farrington.
The act referenced by CMS is the source of the extension of the telehealth flexibilities and GPCI work floor threshold that we discussed in our article "What Radiology Practices Need to Know About The Federal Government Shutdown." Claims for services not covered by the Act will not be held longer than the Medicare claims delay of 14 days that is usually in effect. CMS says that providers may continue to submit claims as usual, and that no claims have been delayed as a result of their initial instructions.
The holding of claims due to the expiration of the GPCI work floor threshold will only affect those payment localities where the work floor would have to be adjusted to less than 1.0 absent any further extension. Payments in unaffected localities should continue as normal. The full list of localities and the amount of the impact for each was reported in our 2024 article.
The government shutdown is an ongoing, uncertain situation, and the Medicare claims processing issues it has created are changing quickly.
Rebecca Farrington is chief revenue officer at Healthcare Administrative Partners.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
