What the 2025 Federal Claims Hold Means for Your Practice

As of October 1, 2025, many healthcare practices across the U.S. have begun noticing delays in Medicare payments, particularly for claims dated on or after October 1. According to the Centers for Medicare & Medicaid Services (CMS), these claims are being temporarily held while Congress debates the renewal of key Medicare payment provisions under the Full-Year Continuing Appropriations and Extensions Act, 2025.

In short:
Claims are still being processed and approved for payment.
But actual disbursement is on temporary hold until further legislative action.

This hold affects:

1. Medicare Physician Fee Schedule (PFS) claims
2. Ground ambulance transport claims
3. Federally Qualified Health Center (FQHC) claims

Providers can continue submitting claims as usual, but payments won’t be released until CMS lifts the hold.

Why It’s Happening

Medicare payment delays 2025

This pause is tied to pending Congressional action. Certain Medicare payment provisions expired on September 30, 2025, and Congress has not yet renewed or extended them. Until that happens, CMS is required by law to hold claims related to those services.

How the Claims Hold Affects Telehealth Coverage 

Several pandemic-era flexibilities for Medicare telehealth coverage have expired. Non-behavioral telehealth visits may not be reimbursable unless renewed by Congress. Practices that expanded telehealth should reassess coverage eligibility and use ABN forms to protect revenue.

This means:

1. Telehealth services provided outside rural areas or to patients at home are no longer reimbursable under standard Medicare rules.
2. Hospice recertifications now require an in-person face-to-face encounter.

If your practice continues to offer telehealth services that may not be covered, consider using an Advance Beneficiary Notice of Noncoverage (ABN) to inform patients ahead of time.

CMS Resources:

1. ABN Forms & Instructions
2. Medicare Telehealth Coverage

What Practices Should Do Now

How to prepare for a claims hold:

1. Continue submitting claims: Don’t hold back submissions; claims will queue up and process faster once the freeze lifts.
2. Communicate with your billing team: Ensure they’re aware of the temporary hold to prevent unnecessary resubmissions or denials.
3. Notify affected patients: Especially those relying on telehealth or covered Medicare services.
4. Monitor CMS updates: The hold could lift as soon as Congress acts; stay tuned to CMS MLN Connects.

The ClinicMind Perspective

At ClinicMind, we’re closely monitoring this situation through our Claims360 Full Billing Service and partner network.
If your practice uses ClinicMind’s EHR + RCM suite, you can:

1. Track all pending Medicare claims automatically within the billing dashboard.
2. Filter and review affected claims by Date of Service (DOS ≥ 10/01/2025).
3. Get real-time claim status updates once CMS releases payments.