The Centers for Medicare & Medicaid Services (CMS) has instructed telehealth providers to retroactively submit claims that were held during the recent government shutdown. This directive allows providers to resume their usual claims submissions until January 30, 2026, when current pandemic-related flexibilities are set to expire unless further legislative action is taken by Congress.
This announcement, made on November 20, 2023, is a crucial step for telehealth providers who faced significant disruptions during the government shutdown. By enabling these providers to submit previously held claims, CMS aims to alleviate some of the financial strain caused by the suspension of operations during that period.
Telehealth services have become increasingly vital, especially during the COVID-19 pandemic, and this move highlights the ongoing need for flexibility in the healthcare system. The agency is also expected to release guidance specifically addressing claims related to the GY-modifier on the same day.
The GY-modifier is a critical component in telehealth billing, allowing providers to indicate that the service provided was not covered by Medicare. Clear guidance on this modifier will help ensure that telehealth claims are processed smoothly and efficiently.
With the expiration of pandemic flexibilities looming, telehealth providers are encouraged to take advantage of this opportunity. Submitting backlogged claims promptly can help mitigate potential revenue losses and ensure that patients continue to receive necessary care without disruption.
As the healthcare landscape evolves, the actions taken by CMS reflect a recognition of the essential role that telehealth services play in delivering care to patients, particularly in underserved areas. The directive also underscores the importance of maintaining continuity in healthcare services as the nation transitions out of the pandemic phase.
In summary, CMS’s directive to telehealth providers to submit held claims, coupled with the forthcoming guidance on GY-modifier claims, represents a significant effort to support the telehealth industry during a critical transitional period. The agency’s proactive approach aims to ensure that telehealth remains a viable option for patients and providers alike.
