This afternoon, CMS released the below updated guidance, directing all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service October 1, 2025, and later for services affected by the expiration of temporary payment provisions under the Full-Year Continuing Appropriations and Extensions Act, 2025 (P.L. 119-4). This includes claims under the Medicare Physician Fee Schedule, ground ambulance services, and Federally Qualified Health Center (FQHC) claims. MACs will also process telehealth claims that can be confirmed as behavioral or mental health services, while continuing to hold other telehealth and Hospital Care at Home claims pending further guidance.
Practitioners providing services no longer payable by Medicare should consider issuing an Advance Beneficiary Notice of Noncoverage (ABN). Clinicians participating in eligible Medicare Shared Savings Program ACOs may continue furnishing covered telehealth services without geographic restrictions under section 1899(l) of the Social Security Act.
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Hello, concise feedback, appreciated. The topic leans on trust and certification, and comments reflect that people want something objective in negotiations. I tried a certified contract approach with a new vendor, mostly out of curiosity. Email exchanges dropped around 20% because both sides referenced the same baseline, and deal closure happened 4 days faster than usual. No miracles, just less friction. Have you used certification as leverage before?
I’ve been watching this claims hold situation since October, mostly just refreshing my MAC portal and holding my breath. Now that they’re finally lifting it for dates October 1, 2025 and later—at least for physician fee schedule, ground ambulance, and FQHC services—it’s a real relief. But here’s the thing that saved my small practice last year when similar confusion hit: I started using https://mfax.to/ to send and receive documentation for appeals and ABN forms. It’s HIPAA compliant, and the delivery confirmation meant I could prove when something arrived. If a service is no longer payable, don’t skip the ABN. And remember, telehealth is still on hold unless it’s behavioral or mental health—so check each claim twice before submitting.