The shutdown began on Oct. 1, after the U.S. Congress could not come together to pass appropriations legislation for the 2026 fiscal year.
The government shutdown of 2025 is expected to end this week as house lawmakers return to vote on a funding bill already approved by the senate.
The shutdown began on Oct. 1, after the U.S. Congress could not come together to pass appropriations legislation for the 2026 fiscal year. As the federal government shutdown disrupts operations across several agencies, the Centers for Medicare & Medicaid Services (CMS) has paused some critical data updates affecting fee schedules. While the direct effect on property and casualty claims payments remains limited, certain medical bill review processes are experiencing downstream impacts.
Recently, PropertyCasualty360.com spoke to Michele Hibbert, senior vice president of regulatory compliance management for Enlyte, about the shutdown’s impact on property and casualty bill review and workers' compensation.
PropertyCasulty360.com: What’s the current status of CMS operations during the federal shutdown?
Hibbert: During the shutdown, CMS is operating with essential staff only and has temporarily paused some data updates. This includes the Medicare “web pricers” used to validate specialized encounters such as long-term care hospital and inpatient rehabilitation discharges.
For FY2026 discharges (effective Oct. 1, 2025), CMS has not yet released updated pricing data. There’s been no public notice or timeline provided for when updates will resume, and changes could occur without prior warning.
PropertyCasulty360.com: How significant is this issue for P&C payers?
Hibbert: The disruption affects only a small subset of P&C bills, primarily those tied to Medicare-based pricing for complex facility services. Most Medicare fee schedules, such as those covering outpatient or office-based services, are not impacted and won’t take effect until 2026.
In practical terms, most bill review operations continue without interruption, and there is no immediate disruption to most fee schedule processing.
PropertyCasulty360.com: How can P&C professionals manage these delays?
Hibbert: Well, at Enlyte, we’ve implemented a proactive strategy to minimize impact and ensure clients experience no service interruptions. This includes using prior year data that’s consistent with past CMS delays, and we’ll continue to temporarily use FY25 data until CMS resumes updates. This process is consistent with how retrospective or late implementation date fee schedules have been handled.
Ongoing monitoring can be a challenge due to the political nature of this shutdown, so that’s why it’s important P&C regulatory professionals actively engage with customer success managers, technical enablement services, and customers to monitor bill volumes and address concerns in real time.
Communication and following any updates regarding regulatory changes is essential. To keep our partners informed, we issue regulatory bulletins and FAQs regarding the shutdown to outline impacts and mitigations to determine next steps.
PropertyCasulty360.com: Should payers or providers hold bills until CMS resumes updates?
Hibbert: No. We do not recommend holding bills. Payers must continue to comply with state laws and timely payment requirements.
While some Medicare administrative contractors (MACs) may be holding certain claim types — such as telehealth, ambulance, and home health services — pending CMS updates, we advise customers to continue processing bills using the most recent available data. Our mitigation strategies mirror those used successfully in the past when state or federal fee schedules were delayed.
PropertyCasulty360.com: What does the shutdown mean for health care providers?
Hibbert: Even during a federal shutdown, Medicare payments typically continue, as Medicare operations are considered essential services funded through trust funds and mandatory spending rather than annual appropriations.
That means claims processing and payments generally remain operational, MACs continue to function during the shutdown and electronic claims submissions and automated payment systems stay active. However, limited-service disruptions can occur. This includes delays in new provider enrollment, slower appeals processing, and temporary pauses in quality reporting or audit activities.
PropertyCasulty360.com: What’s next for the industry?
Hibbert: Enlyte’s regulatory and compliance teams continue to monitor CMS communications and potential impacts to bill review operations closely. We will be distributing a regulatory bulletin with FAQs to Enlyte clients, offering additional guidance and updates. Our priority is ensuring our customers can maintain smooth operations and compliance despite these federal delays.
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