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--- This evening, October 15, 2025, 9pm, EST
Medicare has temporarily paused payments to doctors, community health centers, and ground ambulance providers due to the federal government shutdown. This hold applies to services provided since October 1, 2025, and payments will not be released until Congress acts to fund the government and reauthorize expired programs. This situation is separate from the annual Medicare physician payment cuts and the 2025 reduction that is still in effect.
Why payments are paused
Federal government shutdown: The shutdown that began on October 1, 2025, has triggered the pause in payments because certain Medicare payment programs, such as those for telehealth, have not been reauthorized by Congress.
Expired provisions: The expiration of legislative provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025 has put a hold on payments for services delivered on or after October 1, 2025.
Claims are still being submitted: Providers can continue to submit claims, but the payments will remain on hold until the situation is resolved.
What this means for patients
Potential delays in care: The pause in payments could create delays in accessing care, as doctors and clinics face financial strain.
Impact on specific services: The hold specifically affects services paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and claims from Federally Qualified Health Centers.
Resumption of services: Once Congress acts to fund the government and reauthorize the programs, the hold will be lifted, and claims will be processed.
What this means for doctors
Payment delays: Doctors are experiencing a delay in receiving Medicare payments for services rendered since October 1, 2025.
Impact on clinics: This could create significant financial challenges for physician practices, especially those that rely heavily on Medicare reimbursements.
Need for congressional action: Physicians are waiting for Congress to pass legislation to reopen the government and reauthorize the programs to get paid for their services.
Ongoing payment cuts: This is separate from the 2.8% Medicare physician payment cut that took effect on January 1, 2025, and remains in effect.
What to do if you have questions
Contact your doctor: If you have questions or concerns, contact your doctor's office for information about how this may affect your care or billing.
Contact CMS: For specific questions about your Medicare benefits or claims, you can contact the Centers for Medicare & Medicaid Services (CMS) for the most up-to-date information.
Comments
That headline pretty much sums things up. Hard to tell quite what is happening. With providers and with insurers.
The dateline on this piece is Oct 16th. No wonder it's clear as mud. As Yogi Berra said, it's tough to make predictions, especially about the future.
https://www.goodreads.com/quotes/261863-it-s-tough-to-make-predictions-especially-about-the-future
https://www.beckershospitalreview.com/finance/cms-walks-back-medicare-payment-pause/
CMS has clarified that only select Medicare claims will be held amid the ongoing federal government shutdown, walking back an earlier notice that suggested a broader payment pause.
“In light of the continuing government shutdown, CMS will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions,” the agency said in an Oct. 15 notice. “To date, no payments have been delayed as statute already requires all claims to be held for a minimum of fourteen days, and this recent hold is consistent with that statutory requirement. Providers may continue to submit claims accordingly.”
An earlier version of the notice stated that all payments under the Medicare Physician Fee Schedule, ground ambulance transport claims and all federally qualified health center claims would be temporarily held.
The updated notice specifies that only claims tied to lapsed legislative provisions — such as those for non-behavioral telehealth visits, hospital-at-home care and hospice face-to-face recertifications — will be affected by the hold.
Provisions for those programs expired Oct. 1 after Congress failed to pass a funding bill. The lapse has already led to service disruptions at hospitals and health systems across the country.
About 30% of hospitals have halted Medicare telehealth services amid the shutdown, according to estimates from the American Telemedicine Association. Many systems have also discharged or transferred hospital-at-home patients back to capacity-strained brick-and-mortar facilities as CMS reimbursement for the model lapsed.
Medicare was almost as bad a payor to work with as Trump. They would always delay the late September check to push it into the next fiscal year. They were more prompt than the commercial insurances, but had the right to audit a small fraction of your chart visits ( say 10) and if they found 2 miscoded, would demand a check for 205 of those revenues paid over the last three years on the spot.
They spent a lot of money torturing small practices over junk like this but for some reason could never catch huge practices that were billing millions fraudulently. An ophthalmologist in Florida would use 1/2 of a vial to treat one eye, and open another vial to treat the other eye, and bill Medicare for both vials. Why they couldn't catch that one I will never understand.