Key takeaways from this episode

• The continuing resolution that reopened the government extends the COVID-era telehealth flexibilities through January 30, 2026. None of the amendments touched telehealth; Congress simply struck the old end date and inserted the new one, so the same rule set (patient location, HIPAA-compliant technology, audio and video, physicians working from home) applies.
• Telehealth is back on and you can start billing Medicare telehealth services now. Because the extension runs without interruption, services provided and documented during the shutdown should also be covered, but CMS has not yet told the MACs how to process them or whether there will be another 10-day payment hold; PRS will send an alert when that guidance is released.
• If you had Medicare patients sign an ABN and pay for telehealth during the shutdown, wait for Medicare to process the claim, then refund the patient. As a participating provider you must refund the full amount collected, less any deductible or co-payment shown as patient responsibility on the EOB.
• Refunds of identified overpayments are due within 60 days. The Medicare regulations start the 60-day clock at the point the overpayment is identified.
• If another stalemate looms on January 30, watch whether Congress is heading for another CR or a finalized budget before deciding whether to keep offering telehealth. Another CR would almost certainly extend the same rules; a full budget agreement would need to be read for its telehealth language before you bank on retroactive coverage.
• A mid-year change to the 2026 telehealth rules is unlikely because the Medicare final rule already continues the COVID rules for 2026. Changing them would require rewriting the final rule, so any impact from a budget deal would most likely hit in 2027.
• Commercial payers held steady during the 42- to 46-day shutdown, and Congressman Murphy told the LUGPA meeting telehealth is a bipartisan priority. If payers start pivoting early, that is the signal something has changed; for now all signs point to telehealth being part of Medicare for the long haul.

Transcript

Lightly edited for readability; timestamps mark where each speaker turn begins in the recording. UCR 266, recorded November 2025, with Scott Painter, Mark Painter and Dr. Ray Painter of PRS Network.

The government reopens and the telehealth flexibilities are extended

[00:00] Scott Painter: On this episode: the government shutdown. Actually, the government reopened. What does it do to telehealth? Stay tuned. Welcome to episode 266 of the Urology Coding and Reimbursement Podcast. I'm your host, Scott Painter, with my co-host Mark Painter and Dr. Ray Painter. On this episode we want to talk about the government reopening. This week, as we record this, it is November 14th, and the government earlier this week voted to reopen by passing a new CR, and that impacted telehealth. So Mark, what happened? Can you explain how it affects everybody?

[01:00] Mark Painter: Essentially, the short version is that, as expected, they extended the existing continuing resolution. They did add a few things through some amendments, but none of those amendments, as I've gone through this so far, actually touched the changes in telehealth. That means they essentially extended the COVID flexibilities by striking the end date and inserting a new end date of January 30th, 2026. So we are functioning now under an extension of the COVID rules that goes through January 30th. We'll have to see if the government can actually vote on or deal with any of their other issues so we don't have another shutdown coming. But at this point in time I would say two things.

Number one, telehealth is back on and we can go ahead and start billing telehealth services. And second, the fact that they extended it the way they did does give some hope that even if we have another shutdown, the most likely conclusion is that they will continue to cover telehealth, just not pay for it while the shutdown is on.

The overarching piece I would take from all of this activity is that Medicare, and even Congress, both sides of the aisle, are committed to continuing telehealth for Medicare patients. Now, if we get to a point where we're not pushing forward on a continuing resolution, which could happen at some point, we will probably see some changes to the overall telehealth rules, which is the one thing that gives me pause as we look forward into the future. When I say it gives me pause, I mean the current flexibilities under COVID allow physicians to provide telehealth from their home. It really is about the location of the patient and the use of HIPAA-compliant technology, the allowance for video and audio.

The pieces we do not know at this point, and we do have to take this into account, are what CMS is going to do with this directive. Are they going to ask the MACs to hold payments for another 10 days while they reorganize their payment systems and protocols? That's number one. Number two, now that telehealth is actually covered, as we look at the way this continuing resolution was passed, without interruption through January 30th, if you did provide telehealth services during the government shutdown and documented those, what we don't know is how Medicare is going to ask the MACs to process them based on the continuing resolution. Typically Medicare will issue some guidance. We have not yet seen that guidance issued. We are continuing to watch for instructions to the MACs, and we will keep an eye on those releases as to what Medicare's plan is. As soon as we see a release from Medicare indicating the plan for reopening and processing of claims, we will pass that on to you via an alert.

Refunding patients who paid for telehealth during the shutdown

Scott: All right, I've got a question for you. If you collected money from Medicare patients during the shutdown for telehealth, how do you handle that?

Mark: If there are people out there who elected to have the patient sign an ABN and collected money for telehealth services, you would wait until Medicare reprocesses the claim and you are paid. Once you are paid, then you would issue a refund to your patient for the amount that was covered by Medicare.

Scott: All right. Is there any timeframe for issuing those refunds?

[06:00] Mark: The timeframe stated in the Medicare regs is 60 days. Once you've identified an overpayment, you have 60 days from the identification of the overpayment.

Scott: Ray, any questions?

Dr. Ray Painter: Well, Mark, you said you have to refund the amount the government paid you. What if you charged more than the government paid you?

Mark: As a participating provider for Medicare, you will need to refund the full amount to the patient, less any deductible or co-payment that the patient was responsible for as instructed on the EOB.

Ray: That sounds good. Yes.

What happens if there is another stalemate on January 30th

[07:00] Scott: So what do you see happening on January 30th if this stalemate happens again? Is there anything you've seen that will be different for telehealth come January 31st?

[08:00] Mark: Part of me wants to answer that I don't want to think that far ahead. I hope they actually get their act together and do the right thing here, that they figure out their disagreements, somebody takes the adult pathway and they get this thing done, which probably means both sides figure out how to compromise and get a budget set in place before January 30th. Is there a good likelihood? Certainly the track record doesn't look good.

I do see, as I mentioned, that we've got a commitment for telehealth. So there is a part of me that says we keep going with telehealth, we keep offering that to our patients. The problem I see in blanketly saying go ahead is that I don't know whether they get to January 30th and are once again considering a continuing resolution. If that's the case, then we would expect the rules surrounding telehealth to be extended once again under the same rule set, and that's a definite possibility. So I would wait until January to see where those negotiations are. If it's to the point where they're going to kick the can one more time and push a continuing resolution out the door, then I would feel more comfortable saying keep going. If they are actually close to a finalized budget and have a different agreement in place, then we're going to be looking at the proposed language for that agreement. If that agreement includes telehealth, then we could potentially bank on the fact that it will be implemented or backdated to the point at which the shutdown ends. If that agreement does not include telehealth, or proposes changes to telehealth, then we're going to have to take a different path.

So in the end, it really depends on where Congress is in their negotiations as we get into January. That will make a difference in how I think we're going to react. And again, all of us are going to be jumping into the crystal ball projection scenario, and there are going to be some risks as we go forward. But I am feeling very comfortable now, as we've watched all of this happen, that telehealth is going to be a part of Medicare moving forward. They could have easily dropped it out. We've heard from members of both sides in Congress that telehealth is a much-needed inclusion in the treatment of Medicare patients.

Bipartisan support and how the other payers responded

Scott: And we heard Congressman Murphy at the LUGPA meeting just recently say that telehealth was important and a part of the plan moving forward.

Mark: Yes, and more importantly, he said it's a bipartisan issue that they have little disagreement on.

[11:00] Scott: Well, I guess there's some good news that came out of it all. That does give us the reassurance that telehealth is likely a part of Medicare for the long haul. That's good news, and it's also good to see that none of the other payers flinched when this was happening in Medicare as far as telehealth.

[12:00] Mark: Yes. In the end, the fact that it went 46 or 42 days and we saw a behavioral pattern that was essentially a holding pattern, I think that really tells us the scuttlebutt on the back end, because everyone has lobbyists and connections, or at least the big players within the insurance companies do have those connections. That told us we weren't going to see a major change. If we start to see payers making pivots early on, that's when we're going to know things are going to be different. Right now, all signs point to yes, as the magic eight ball would tell us.

Scott: All right, Ray, any final comments from you on telehealth?

Ray: No, I think you can be optimistic about telehealth. All the logic and everything both parties have done would point to the fact that we're going to be good on telehealth. You mentioned one time that there may be some change in the rules, but you think overall the routine telehealth is going to continue. I like that approach.

[13:00] Mark: Yes. The final rule for Medicare was really set up for a continuation of the COVID rules, so that's 2026. The likelihood that they would change mid-year is lower, so that's the other part of this. And again, everything could change; that's where we are. But the likelihood of a budget rule changing the telehealth rules in 2026, even with a longer-term budget, is low. That would require a rewrite of the final rule. As we've watched regulations come through in the past, most of the impacts of any change would likely hit for 2027, not 2026. So that's the other part that gives me some comfort: the easiest way through 2026 is a continuation of what exists right now, and that gives me some confidence in saying, yes, you could keep going. That would be the most likely path forward if we're going to continue to see telehealth. And as we've said again and again, telehealth looks like a part of Medicare for the long haul.

Sponsor, final thoughts and the Las Vegas seminar

[14:00] Scott: Okay. Well, let's wrap this episode up here. We want to thank ModMed for supporting this episode. If you're in the market for an EHR or a practice management system, you can go to modmed.com/prsnetwork for specials for our listening audience. All right, let's get some final thoughts. Mark, any final thoughts today?

Mark: I think I've given you a lot of my final thoughts throughout the program today, so I can certainly restate them. Telehealth is in; we're going to have to wait to see how it's processed. So I'll give you a summary: telehealth is back on, at least until January 30th. It likely will continue beyond that. We don't know exactly how Medicare is going to process everything and whether or not we're going to see any payment holds. We will find that out shortly, and we need to keep an eye on that.

Scott: Great. Ray, any final thoughts?

[15:00] Ray: Not really. I'd just like to express my optimism as well, and hopefully the politicians have learned a lesson, and we will give them all a hard time so they'll know that neither side won, and they'll come together and act like a Congress and hopefully avoid this in the future. But I think telehealth is here to stay as well.

Scott: Agreed. All right, that's all we have for today. We want to let you know that our Urology Advanced Coding and Reimbursement Seminar in Las Vegas is coming up in three weeks, December 5th and 6th, 2025. We'd love to see you there. Get prepared for all the new rules, new codes, new drugs, all the new things coming up for 2026. You can go to prsnetwork.com, and right there on the homepage there's a seminar registration button you can click to register. We hope to see you there. That's all we have for you today. Thank you all for listening. Take us out, Ray.

[16:00] Ray: Happy coding.

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