The following is a summary of information received from the Centers for Medicare and Medicaid Services

Tennessee’s Medicare Administrative Contractor, Palmetto GBA, will be placing an up to 10-day hold on Medicare claims payments. When certain Medicare payment rules are about to expire, the Centers for Medicare & Medicaid Services (CMS) puts a temporary hold on processing payments. This is routine and helps ensure payments are made correctly, especially if Congress decides to change or extend the rules after they expire. Providers can still send in claims, but payments won’t go out until the hold ends. Most providers shouldn’t be affected much by the delay.

Starting October 1, 2025, unless Congress takes action, many of the temporary flexibilities for telehealth services (put in place during COVID-19) will end for non-mental health services. This means:

• Some telehealth services won’t be allowed for patients at home or outside rural areas
• Certain services, like hospice re-certifications, will again require in-person visits
• This could affect patients’ ability to keep getting some Medicare benefits
• Providers offering telehealth that won’t be covered by Medicare may want to give patients a notice (Advance Beneficiary Notice of Noncoverage) to inform them they may have to pay
• Providers might consider holding telehealth claims that wouldn’t be paid until Congress makes a decision
• Some types of providers may not be allowed to get paid for telehealth services under the old rules

However, some ACOs (Accountable Care Organizations) will still be allowed to offer and get paid for certain telehealth services, even without new Congressional action, thanks to a 2018 law. These ACOs don’t need special permission to do this.

For more information check out the Telehealth Factsheet here.