The Centers for Medicare & Medicaid Services (CMS) DME MAC contractors have issued reminders that claims for durable medical equipment (DME) are now on hold due to the federal government shutdown that started Oct. 1.
“When certain legislative payment provisions (“extenders”) are scheduled to expire, CMS [Centers for Medicare & Medicaid Services] directs all Medicare Administrative Contractors (MACs) to implement a temporary claims hold,” Noridian Healthcare Solutions, the Jurisdiction A and D DME MAC, said in an Oct. 1 email to stakeholders. “This standard practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements.”
The purpose of the hold is to prevent the need to reprocess large numbers 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,” the announcement said.
Providers can continue to submit claims, “but payment will not be released until the hold is lifted,” Noridian added.
Later on Oct. 1, CGS Administrators — the DME MAC for Jurisdictions B and C — emailed the same notice to stakeholders.
The announcement also noted that telehealth flexibilities, which began during the COVID-19 pandemic and were extended several times via federal continuing resolutions, ended Oct. 1.
“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,” the DME MAC notice said. “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 Oct. 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.”
Telehealth Modernization Act bills are currently in the U.S. House of Representatives (H.R. 5081) and U.S. Senate (S. 2709).
The American Occupational Therapy Association (AOTA) said in a Sept. 26 announcement that it did not expect Congress to act in time to avoid the expiration of telehealth flexibilities on Oct. 1. Noting that occupational therapy practitioners would no longer be reimbursed if the flexibilities expired, the AOTA shared suggestions for clinicians dealing with the telehealth expiration.
The American Physical Therapy Association (APTA) updated its “shutdown FAQs” webpage to explain to physical therapy practitioners the changes caused by the government shutdown and expiration of telehealth flexibilities.
