The Centers for Medicare & Medicaid Services (CMS) has issued new guidance for telehealth providers impacted by the government shutdown.
While Congress stood at an impasse over the Affordable Care Act premium tax credits, the body allowed other programs, like telehealth and the Acute Hospital Care at Home program, to temporarily lapse.
Providers that continued to see Medicare patients via telehealth during the 43-day government shutdown were not reimbursed. The Medicare telehealth flexibilities were restored when the government reopened Nov. 12, but Congress only extended them until Jan. 30, 2026.
The continuing resolution that reopened the government included language that allows telehealth providers to be retroactively reimbursed for services they provided during the shutdown. However, the industry was awaiting CMS guidance on the topic once the agency had time to review the legislation.
Thursday, the agency released a revised frequently asked questions document (PDF) saying that Medicare telehealth providers can submit any claims they held during the government shutdown to Medicare Administrative Contractors (MACs)—the regional bodies that adjudicate Medicare claims—for reimbursement.
Similarly, clinicians can now resubmit any claims that were rejected by MACs during the shutdown for payment, including for the Acute Hospital Care at Home program. McDermott+ Consulting advised clients to review which beneficiaries were charged for telehealth services during the shutdown, refund them and submit those claims to Medicare instead.
The agency likewise clarified other payment issues that arose from the shutdown in its updated Medicare claims processing guidance (PDF). The updated guidance includes information on payment adjustments for low-volume inpatient hospitals and for the Medicare-dependent hospital program.
In the updated FAQ, the CMS also remedied an outstanding issue for providers conducting telehealth services from their homes.
Per CMS rules, Medicare telehealth providers would have been required to begin reporting their home addresses as a practice location to the CMS and have them listed on public websites beginning Jan. 1.
Telehealth lobbyists said reporting providers’ home addresses to the public was a safety issue for providers. It would also be an additional administrative burden for practices, they said.
The CMS clarified in the FAQ that Medicare telehealth providers do not have to report their home addresses to the agency if they also have a physical practice location they report to the agency. Telehealth providers that exclusively work from home must submit their home address to the CMS but have the ability to suppress it from public view by marking it on their enrollment application.
“CMS’ guidance is a welcome, commonsense step that spares providers needless red tape,” Chris Adamec, executive director of the Alliance for Connected Care, said in a statement. “It enables the flexibility in how and when telehealth is delivered that is key to driving patient-centered care. We’re ready to help CMS take the next step and extend a similar approach to providers without physical practice suites.”