The Centers for Medicare and Medicaid Services (CMS) recently directed Medicare Administrative Contractors (MACs) to hold Medicare fee-for-service (FFS) claims for ten business days, due to the expiration of several Medicare payment provisions and the Oct. 1 federal government shutdown. This action is to prevent the need to reprocess large volumes of claims if congressional action extends payment provisions such as the low volume adjustment and the Medicare dependent hospital program. The CMS believes the temporary hold will have minimal impact on providers due to the 14-day payment floor. Providers may continue submitting claims, but payment will not be released until the hold is lifted.
The MHA confirmed that this does not impact bi-weekly Medicare FFS periodic interim payments and that Medicare Advantage payments to hospitals should not be impacted.
Several temporary telehealth waivers expired Sept. 30, resulting in statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency taking effect Oct. 1 for services other than behavioral and mental health services. 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.
The acute hospital-at-home program also expired on Sept. 30. The CMS instructed all hospitals with active waivers to discharge all patients or return them to the “brick and mortar” inpatient hospital setting.
The MHA will continue working with congressional delegation to minimize the impact of the shutdown on providers and will provide additional information as it becomes available. AHA members can access the latest AHA advisory for additional details. Members with questions may contact Vickie Kunz at the MHA.