Payment delays are creating new challenges for Critical Access Hospitals (CAHs) billing under Method II. Recent changes from the Centers for Medicare and Medicaid Services (CMS) aimed at preventing denials and slowed reimbursements, even for fully compliant providers. Here is what is happening, why it matters, and what steps your hospital can take now.
What’s Happening?
Since July 1, 2025, many CAHs have been experiencing delays or denials for Method II professional service claims — even when billing is correct.
This issue stems from new CMS rules (Transmittal 13041) intended to prevent duplicate billing between Method II CAHs and practitioners. Unfortunately, it is affecting compliant providers nationwide.
What Can You Do?
- If your hospital is experiencing denials, try recredentialing your practitioners in PECOS
- Alert billing/business office staff to monitor claims for denials
CMS is aware of the issue and working on a resolve. DZA will continue to monitor the situation closely and share updates as soon as new information becomes available.
Please feel free to contact DZA with any questions or concerns you may have.
Tristi Cohelan
Principal
