decisionhealth Newsletters, Part B News - 2025 Issue 11 (November)
MACs start processing and paying claims, but telehealth remains blocked
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Article Overview
This article covers a CMS operational update affecting Medicare claims during the federal shutdown. It explains the status of held claim payments, the role of Medicare administrative contractors, and which provider payment activities are resuming versus remaining paused. It also discusses the continued interruption of certain telehealth and home-based care flexibilities, along with general revenue-cycle monitoring considerations for providers and billing staff.
Why This Topic Matters
Providers, billing teams, and revenue-cycle managers need to know when Medicare payments are resuming, which services may still face delays, and which temporary policy flexibilities remain unavailable. The article helps readers track shutdown-related operational changes that can affect cash flow, claim timing, and administrative follow-up.
Article Sections
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Physician payments
Covers the CMS update on Medicare claims holding and the restart of processing for certain services. Discusses contractor payment flow, backlog timing, and the types of administrative functions affected by the shutdown.
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Watch out for some exceptions
Reviews payment-related areas that may not be fully restored and identifies policy items that remain affected by the shutdown. Includes broad discussion of geographic payment adjustments, telehealth-related flexibilities, and a home-based care waiver program.
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6 steps to take
Summarizes general revenue-cycle precautions and monitoring steps for providers as claims resume processing. Focuses on operational follow-up, claim hygiene, and cash-flow management.
What You Will Learn
- How the shutdown affected Medicare claim holds and payment processing
- Which broad Medicare payment operations are described as resuming or remaining paused
- What provider teams should monitor as held claims begin clearing
- Which temporary policy areas are discussed as still affected by the shutdown
- What general revenue-cycle follow-up steps are recommended in the article
Who Should Read This
- Physicians and other Medicare-participating providers
- Medical billing and coding staff
- Revenue cycle managers
- Practice administrators
- Healthcare compliance and reimbursement teams
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