CMS just announced that it has directed its MACs to lift the hold on Medicare ambulance claims. This means that claims with dates of service on or after 10/01/25 should be processed and paid (where covered) by Medicare.
However, PWW is receiving multiple reports of claims being paid WITH the temporary add-on bonuses (2% urban, 3% rural and 22.6% super rural). Because the extenders expired on September 30th, CMS has no statutory authority to pay ambulance claims with the bonus amounts.
This will not be a problem so long as Congress reinstates the bonuses within 60 days of when the claims are paid. If they do not extend the add-on payments, then claims paid with those bonus amounts technically constitute overpayments under the law (barring any future legislative change to that rule). If these payments are deemed to be overpayments, ambulance services WOULD have refund obligations for those bonus amounts absent a Congressional extension of the bonus payments.
Until these issues come into sharper focus, we continue to recommend that ambulance services HOLD their Medicare claims until Congress acts on the ambulance extenders. If your cash flow or cash reserves (or tax support or subsidy) allow your organization to weather this period without your Medicare cash flow, holding claims would avoid both potential overpayment refunds or claims reprocessing issues.
The PWW team is currently gathered with hundreds of attendees from across the country at our abc360 conference in Hershey, monitoring the situation, and will provide updates and answer your questions as timely as we can. Please stay tuned and reach out to PWW|AG and it's consultants for more information.
