Reliable Billing, LLC

11/20/2025

Latest update on telemed:
Provider alert
Medicare Plus BlueSM and BCN AdvantageSM
Category: Behavioral health, Billing/claims/coding
Date posted: Nov. 12, 2025
CMS enforces continuation of telehealth flexibilities through
Dec. 31, 2025
We published a provider alert on Sept. 24 informing providers that the Centers for
Medicare & Medicaid Services was ending certain telehealth flexibilities on Sept. 30,
2025, and that Blue Cross Blue Shield of Michigan and Blue Care Network follow CMS
guidance and would align with their telehealth coverage.
However, CMS is enforcing the prohibition of mid-year benefit changes by Medicare
Advantage organizations for certain telehealth benefits. According to federal regulation
42 CFR § 422.101(a), Medicare Advantage organizations must cover all Original
Medicare Part A and B benefits, including telehealth services authorized by
section1834(m) of the Full-Year Continuing Appropriations and Extensions Act, 2025.
Effective immediately, we’re following CMS guidelines and will continue covering certain
telehealth services that expired on Oct. 1, 2025, as additional telehealth benefits, but
only if provided by our contracted providers as required by 42 CFR § 422.135(d). These
telehealth services are covered through Dec. 31, 2025, or until Congress extends the
original waivers, whichever occurs first.
We’ll continue to monitor the situation and issue further guidance as needed.
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11/05/2025

More Michiganders Are Appealing Denied Health Insurance Claims with Help through DIFS’ Free Process – Here’s How
DIFS launches a public awareness campaign to explain how Michiganders can use the Patient’s Right to Independent Review Act

Media Contact: DIFS-press@michigan.gov
Consumer Hotline: 877-999-6442, Michigan.gov/DIFScomplaints

FOR IMMEDIATE RELEASE: November 5, 2025

(LANSING, MICH) – The Michigan Department of Insurance and Financial Services (DIFS) announced that more Michiganders are appealing health insurance claim denials under the Patient’s Right to Independent Review Act (PRIRA).

“When a health insurance company says ‘no’ to a treatment their doctor says is necessary, consumers should know that that does not have to be the final word,” said DIFS Director Anita Fox. “Michiganders have the right to an impartial, expert review of final health insurance claim denials to ensure they obtain the health care services to which they are entitled. You can reach DIFS by calling 877-999-6442, Monday through Friday from 8 a.m. to 5 p.m., or by visiting Michigan.gov/HealthInsuranceAppeal.

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10/30/2025

Happy Halloween!

10/21/2025

Update on Medicare telemedicine:
Claims Hold Update

CMS instructed all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service of October 1, 2025, and later for certain services impacted by select expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025 (Pub. L. 119-4, Mar. 15, 2025). This includes claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims. This includes telehealth claims that CMS can confirm are definitively for behavioral and mental health services. CMS has directed all MACs to continue to temporarily hold claims for other telehealth services (i.e. those that CMS cannot confirm are definitively for behavioral and mental health services) and for acute Hospital Care at Home claims.

Beginning October 1, 2025, for services that are not behavioral health services, many of the statutory limitations on payment for Medicare telehealth services that were, in response to the COVID-19 Public Health Emergency, lifted, and subsequently extended, through legislation again took effect. These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas, and hospice recertifications that require a face-to-face encounter. In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage (ABN). Further information on use of the ABN, including ABN forms and form instructions: https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn [links-2.govdelivery.com]. Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are currently not payable by Medicare in the absence of Congressional action. For further information: https://www.cms.gov/medicare/coverage/telehealth [links-2.govdelivery.com].

Find links to Medicare payment amounts and policies, a list of covered telehealth services, and how to request coverage of a service be via telehealth.

09/23/2025

Phones are out today. Spectrum is working to get us back up quickly. Apologies for any inconvenience. Reach out via email: elizabeth@reliablebilling.net for now. Thanks

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09/15/2025

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07/17/2025

Physicians who treated patients covered by Blue Cross Blue Shield (BCBS) over a 16-year span ending in 2024 may be eligible for a payment from a $2.8 billion legal settlement. The deadline to submit a claim is July 29, 2025.

Physicians who treated patients covered by Blue Cross Blue Shield over a 16-year span ending in 2024 may be eligible for a payment from a $2.8 billion legal settlement.

07/15/2025

Happening as this is being posted. Always a classic! 😅😂🤣

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07/03/2025

https://www.facebook.com/share/v/1ZX4jwGDoQ/

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