When the Calm of Summer Gives Way to Autumn Chaos
The easy pace of summer has faded into fall’s familiar rush — lunchboxes packed before dawn, school bells ringing, and inboxes overflowing. For healthcare providers, that same hectic rhythm feels familiar: CMS has announced another delay, extending its hold on telehealth‑related Medicare claims.
According to the October 15 MLN Connects Newsletter, CMS directed all Medicare Administrative Contractors (MACs) to continue temporarily holding Medicare claims for services tied to expired payment provisions [MLN Connects Oct 15 2025].cms
This hold applies to:
- Telehealth services under the Medicare Physician Fee Schedule
- Ground ambulance transports
- Federally Qualified Health Center (FQHC) visitscmadocs+1
Providers may continue submitting claims, but CMS will not release payments until Congress renews the associated legislative authority.
The New Season, Old Rules Return
As of October 1, Medicare reverted to pre‑pandemic telehealth rules:
- Non‑behavioral telehealth visits outside rural areas or patient homes = no longer billable.
- Behavioral health and substance‑use telehealth services remain covered.
- Providers must issue Advance Beneficiary Notices (ABNs) for services not reimbursed.cms+1
Official CMS ABN forms and instructions:
https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn
Clinicians in Shared Savings Program ACOs can still bill covered telehealth claims without geographic restrictions — one bit of good news in an otherwise choppy transition.cgsmedicare+1
Routines Reset, Patience Required
CMS’s move is procedural, but the timing couldn’t feel more familiar: it’s like the first week back to school — structured on paper, chaotic in practice.
The 14‑day Medicare payment floor cushions the first impact, yet longer gridlock could push delays well into November .ahcancal+1
Providers are advised to:
- Keep billing on schedule to ensure automatic release once authority resumes.
- Track affected claims separately.
- Stay current on CMS communications to anticipate quick payment reinstatement.
Helpful CMS Resources
- CMS Telehealth Information Page
- Telehealth FAQ (Updated October 14 2025)
- MLN Connects Newsletter – October 15 2025
Final Thought – Coffee, Compliance, and Patience
Fall brings early mornings, late nights, and packed schedules — and this year, it brings delayed Medicare reimbursements, too.
Still, like any season, this will pass. Once Congress renews the payment provisions, CMS will release those queued claims and the rhythm will even out.
Until then, stay current, stay accurate, and if all else fails — reach for another cup of coffee (pumpkin spice optional).
Author Bio
Written by Wendy Samuels, Healthcare Revenue Cycle Specialist.
Wendy has over 30 years of experience in medical billing, coding, and compliance. She leads education and policy work with AIE Medical Management, helping providers navigate Medicare billing changes with clarity and confidence.
She’s passionate about helping healthcare professionals get paid accurately and compliantly — without the jargon.
