Hold on all Medicare claims while awaiting Congressional action may present risk of cash delays for providers


A likely Congressional action to extend the suspension of the 2% sequestration on Medicare payments is welcome news to healthcare providers, but a hold on claims until such action is taken may cause temporary headaches in the form of potential cash delays.

The Senate passed legislation to extend the suspension of sequestration on March 25, 2021 and the House is expected to pass it following the Easter recess in the next session on April 13, 2021. 

In a newsletter dated March 30, CMS announced an instruction to the MACs to “hold all claims with dates of service on or after April 1, 2021.” The intent of the hold is to ensure the MACs do not need to reprocess claims at a later date. However, this instruction gave providers little time to prepare, particularly when considering the potential risk as this impacts all claims both inpatient and outpatient. CMS states the hold will last “a short period without affecting providers’ cash flow.” However, the “short period” has not been defined and the impact on providers could be significant if Congress does not extend the suspension in a timely manner. 

It will be crucial to closely monitor the status and quantify the impact of all held claims during this period. Additionally, it is advantageous for providers to confirm that the managed Medicare payers will not be following CMS’s lead.

By David Gaffey,
Vice President, Revenue Cycle
Ensemble Health Partners