10/29/2025

CMS Claims Update

Updates and solutions for the CMS claims

On October 21, CMS released updated guidance lifting many of the temporary claims holds. The temporary claims hold was lifted for claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims. Claims holds on behavioral and mental health services have also been lifted.

CMS has directed all MACs to continue to temporarily hold claims for telehealth services that CMS cannot confirm are definitively for behavioral and mental health services. CMS has also directed all MACs to continue to temporarily hold Hospital Care at Home claims.

CMS will also continue to pay Medicaid reimbursement as long as funds allow without a reauthorization in appropriations. APMA will not know how long CMS Medicaid reimbursement will continue until shutdown contingency instructions are released. Additionally, providers may have delays in responses to billing questions and process enrollment applications because the employees for these functions are paid through annual appropriations and could be affected by the shutdown.

The Department of Veterans Affairs (VA) will require physicians to report to work and deliver clinical care, but there will be a delay in reimbursement and administrative functions. The VA recently released its shutdown contingency instructions. 

Members with questions about payments may contact CGS, and the MAC for Ohio - J15 Part B Customer Service.

Offices may also submit a request to the CSG Accelerated and Advanced Payments Program - Accelerated and Advance Payments.