BC Advantage - 2025 Issue 11
Claims Hold Update
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Article Overview
This article explains a Medicare claims-hold update issued by CMS and outlines which categories of claims are being processed, which remain temporarily held, and how recent legislative timing affects telehealth and related services. It is intended for billing and coding professionals, compliance staff, and providers who need to track Medicare payment status, telehealth coverage changes, and related CMS guidance. The article also points readers to CMS resources on beneficiary notice use and Medicare telehealth policy, and references special telehealth flexibilities for applicable ACOs.
Why This Topic Matters
The update affects claim submission, payment timing, and coverage awareness for several Medicare service categories. It is especially relevant for organizations that bill telehealth and other affected services and need to monitor changing federal payment policy.
What You Will Learn
- Which broad categories of Medicare claims are affected by the CMS hold update
- How the timing of expired legislative payment provisions affects telehealth and related services
- What CMS says about temporary holds, beneficiary notices, and related telehealth resources
- How special telehealth flexibilities apply to certain Medicare Shared Savings Program ACOs
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance teams
- Physicians and other Medicare-enrolled clinicians
- ACO participants and administrators
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