CMS lifts claims processing hold for certain services

CMS directed Medicare Administrative Contractors (MAC) to lift the claims processing hold issued earlier this month for certain services impacted by the government shutdown. The agency instructed all MACs to process claims with dates of service on or after October 1 for Medicare Physician Fee Schedule, ground ambulance transport, and federally qualified health center claims.

The hold is also lifted for telehealth claims that CMS can confirm are definitively for behavioral or mental health services, according to the update. However, the agency instructed all MACs to continue the processing hold for other telehealth services, as well as Acute Hospital Care at Home claims.

CMS reiterated that any organization that furnishes telehealth services not payable by Medicare on or after October 1 should consider providing beneficiaries with an Advance Beneficiary Notice of Non-Coverage.

CMS originally ordered the hold to prevent the need for reprocessing large claim volumes before lawmakers reach a resolution and end the shutdown. Organizations were authorized to continue submitting claims during the hold but were notified that payment would not be issued until it was lifted. On October 15, the agency clarified that it will continue to pay and process affected claims in a timely fashion "with the exception of select claims for services impacted by the expired provisions."

Revenue integrity professionals must monitor for additional claims processing updates and other instructions from CMS throughout the government shutdown. Review Medicare telehealth policies and ensure your team understands how the shutdown is impacting operations.