This is day 27 of the partial government shutdown.
The ongoing government shutdown will likely affect Social Security Disability (SSDI) recipients who are applying for Medicare. By law, SSDI recipients must wait two years from the date of their receipt of disability benefits to qualify for Medicare. Delays in decisions caused by the shutdown could have a significant impact on these individuals. The President has vowed that he “won’t budge an inch” and is ready for the shutdown to “last for years.”
SSDI is available to Americans who have worked and paid into Social Security for a required number of quarters and face a long-term disability that limits their ability to work. After an application is approved, recipients get between $700 and $1,700 per month in disability insurance payments. The application process is long, and status is often only granted after an appeal.
The good news is that during the shutdown, people already receiving SSDI payments will continue to receive those payments. The bad news is that for people waiting on hearings and processing of their SSDI applications may see a huge slowdown. People waiting to get their Medicare benefits after being on SSDI for over two years may also have to wait to get their Medicare cards.
While judges are still working without pay, the administrative staff that assists with processing SSDI requests and hearings have been furloughed.
Some states give SSDI recipients medical assistance. Some people on SSDI qualify for Medicaid. If SSDI recipients do not receive medical assistance, medical expenses could possibly wipe out all of their SSDI benefits.
In a double whammy, under the new financial rules governing revenue recognition, healthcare entities can’t recognize revenue for patients that qualify for SSDI Medicare but have had the application process stopped by the furlough of federal workers.
How does this work in the real world? Let’s say a patient is admitted to a hospital. They have been on SSDI for over two years and are waiting for their Medicare card. The hospital treats the patient waiting to bill Medicare for the stay. As a result of the shutdown, the Medicare card has not been issued. Since they can’t determine who is the contracted party or the amount that will be realized at the end of the period, for financial statement purposes, they can’t recognize revenue for the patient. The timing of the shutdown couldn’t be worse: it is hitting at year’s end for all healthcare providers.
New accounting rules require that healthcare entities “identify the contract(s) with a customer.” This means that for Medicaid pending and now SSDI Medicare pending patients, healthcare entities can’t recognize revenue until the patient is actually enrolled in Medicaid or Medicare.
Disabled Americans that may have used SSDI payments (yet been slowed by the shutdown) to pay medical expenses will most likely end up as charity cases for hospitals and healthcare providers. And again, SSDI recipients that should get their Medicare cards may not get them during the shutdown. Will healthcare providers be able to retroactively bill Medicare when the Medicare benefits are finally issued? It is currently up for debate.
Clinical documentation integrity (CDI) professionals and inpatient coders understand the relationship between the Inpatient Prospective Payment System (IPPS) and hospital reimbursement. However, they may be
Data has become one of the most powerful assets in healthcare, but its value is realized only when leaders possess the literacy to interpret, question,
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
