The Government Shutdown and Healthcare Claim Processing

CMS has instructed all Medicare Contractors (MACs) to perform all claim processing functions during the government shutdown.  This includes the processing of claim files and the creation of response files (835, 999, 277CA).  Based on our internal operations regarding these processes, we have seen no impact on these activities from any contractor.  Medicare and Medicaid payments should not be delayed.

However, the shutdown will have an impact on other administrative activities that may impact reimbursement in the long run.  All activities related to surveys and certifications have been suspended.  This includes the authorization of new agencies to conduct these transactions or obtain Medicare certification and the termination of certification for organizations under investigation. 

The shutdown has also affected the organizations in the government involved in making or modifying new rules for these operations.  Depending on the length of the shutdown, this may affect deadlines associated with the implementation of new fee schedules associated with physician payments and ambulatory surgical centers.

Many types of survey activities have been suspended including Medicare recertification.  OIG investigations have been suspended except for those that may involve immediate harm associated with the outcome.  The fraud and abuse hotline has been suspended.  HHS expects that about half of their employees will be furloughed.  All new grant activities have been suspended as well as any other programs from the CDC and the FDA that are not supported by user fees including the annual seasonal flu shot programs.

Expect more reductions in services if the delay in funding continues.


By Kalon Mitchell – President, MEDTranDirect

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