Medicare Reimbursements Delayed After Government Shutdown
Understanding the Impact of the GPCI Floor Expiration on Your Medicare Revenue
If you operate a medical practice or clinic in a geographic area where the cost of physician labor is below the national average, such as Arkansas or Kansas, you may have noticed a delay or even a dip in Medicare reimbursements this month. The issue isn’t just an accounting hiccup. It is directly tied to the federal government shutdown and the expiration of key Medicare payment provisions that ended on Sept. 30, 2025.
What Happened: A Funding Gap & Policy Expiration Collide
When Congress did not pass a full-year spending bill, several healthcare payment provisions expired. One of the most important was the 1.0 Work Geographic Practice Cost Index (GPCI) floor, which for years ensured that physician reimbursements in lower-cost areas would not fall below the national average.
According to the Centers for Medicare & Medicaid Services (CMS), the expiration of this floor triggered a temporary hold on certain Medicare claims. This affects payments for services provided on or after Oct. 1, 2025 in regions where the GPCI dropped below 1.0.
For example:
- Arkansas: The Work GPCI fell to 0.955
- Kansas: The Work GPCI fell to 0.969
Why It Matters for Your Practice
This change affects more than billing. For many practices, it impacts revenue, payroll and planning.
The American Medical Association reports that physicians in states like Kansas and Arkansas are among the most affected because they, along with others, depend heavily on Medicare fee schedules for patient services.
What You Should Do Now
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Review your Medicare Payments
Run reports for all services provided after October 1 and compare payments to prior months to identify reductions or delays.
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Communicate with your Billing Team
Make sure your billing staff is aware of the GPCI change and tracking reimbursement differences. Follow up on any claims that appear to be held.
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Adjust Financial Forecasts
Reassess your cash flow and operating budgets for the fourth quarter. Consider temporary spending freezes or short-term financing if needed.
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Join Advocacy Efforts
Share your data with the Kansas Medical Society or Arkansas Medical Society. These groups are collecting information to push Congress to restore the 1.0 GPCI floor.
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Plan for Legislative Delays
Even if Congress acts, reinstatement may take time. Assume current payment levels could last through the end of the year.
If you would like to help analyze how these reimbursement changes affect your practice, Adams Brown’s healthcare advisors are here to support you. Our team helps healthcare business owners stay focused on patient care while maintaining financial stability through regulatory changes.
