Relevant, Timely Medical and Radiation Oncology News
Constant advancements in medical technology and healthcare regulations mean the oncology industry is dynamic and fast-changing. To keep clients on the leading edge of what's happening, Revenue Cycle Inc. maintains the news section of its website as a clearinghouse for oncology news, CPT® coding and/or business operations. Whether it's a legal change that could affect our industry or a tip about oncology coding, you'll find it here.
For more information about how our team of expert consultants can help your practice stay current on these industry changes, visit our medical and radiation oncology service page.
September 2016 Radiation Oncology News
CMS Builds Meaningful Use Public Health Reporting Repository
Pam Phipps, RN, BSN
In order for eligible providers and eligible hospitals to meet meaningful use requirements for public health reporting, CMS is building a central repository, the federal agency announced September 16, 2016.
This repository will show which public health agencies (PHAs) and clinical data registries (CDRs) are ready to receive electronic public health reporting, which helps eligible providers and eligible hospitals in meaningful use attestation. It will also indicate the readiness of PHAs and CDRs to receive data electronically and ultimately help providers fulfill public health reporting requirements.
The meaningful use requirements, which were published in the October 2015 final rule, call for eligible providers, eligible hospitals and critical access hospitals to demonstrate their ability to send data to PHAs and CDRs.
There are seven possible health measures to report; only one of the seven is required to be reported by the eligible provider or eligible hospital. In order to join the PHA and CDR repository, qualifying entities must identify which of the following public health measures they report:
- Immunization registry
- Syndromic surveillance reporting
- Specialized registry reporting
- Electronic reportable laboratory result reporting
- Electronic case reporting
- Public health registry reporting
- Clinical data registry reporting
Registries may join the repository using a CMS input form (found on the CMS website), declaring their readiness to receive public health reporting. To be eligible for the 2017 repository, registries must submit the input form between September 1 and October 31, 2016.
Stay on top of CMS announcements and ahead of important deadlines—take advantage of the readily accessible news and expertise Revenue Cycle Inc. provides through our Client Resource Center. For more information about an annual subscription and how our consulting services can help your practice and facility stay abreast of process updates, code changes, and industry news,please contact us at www.revenuecycleinc.com or 512-583-2000.
June 2016 Medical Oncology News
New January 3, 2017 Effective Date for the JW Modifier
Gigi Price, R.N., O.C.N., CHONC
The requirements for the use of the JW modifier are changing—is your organization ready? Historically, the JW modifier has been available for reporting drug waste from a single dose vial (SDV); however, it hasn’t been required. CMS recently released new guidance on the use of the modifier, outlining the requirements and upcoming implementation dates.
New information was released June 13, 2016, delaying the implementation for use of the JW modifier. CMS issued the following information:
MLN Matters® Number: MM9603 Revised
Related Change Request (CR) #: CR 9603
Related CR Release Date: June 9, 2016
Effective Date: January 1, 2017
Related CR Transmittal #: R3539CP
Implementation Date: January 3, 2017
“Transmittal 3530, dated May 24, 2016, is being rescinded and replaced by Transmittal 3538 to update the Effective and Implementation dates. All other information remains the same.”
“The official instruction, CR9603, issued to your MAC regarding this change is available here.”
The following was published within MLN Matters® Number: MM9603, April 29, 2016 and was updated June 9, 2016, JW Modifier: Drug Amount Discarded/Not Administered to any Patient. The effective date is January 1, 2017, and the implementation date is January 3, 2017.
“The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 9603 to alert MACs and providers of the change in policy regarding the use of the JW modifier for discarded Part B drugs and biologicals.
Effective January 1, 2017, providers are required to:
- Use the JW modifier for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals) and
- Document the discarded drug or biological in the patient's medical record when submitting claims with unused Part B drugs or biologicals from single use vials or single use packages that are appropriately discarded
Make sure that your billing staffs are aware of these changes. Remember that the JW modifier is not used on claims for CAP drugs and biologicals.”
In addition, CR 9603 published the July 1, 2016, changes to Medicare Claims Processing Manual, Chapter 17 - Drugs and Biologicals, regarding the use of the JW modifier and updated it on June 9, 2016. An excerpt is provided here for reference:
"Effective January 1, 2017 when processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals (CAP)), local contractors shall require the use of the modifier JW to identify unused drugs or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological. For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units shall be billed on another line by using the JW modifier. Both line items would be processed for payment. Providers must record the discarded amounts of drugs and biologicals in the patient’s medical record.
The JW modifier is only applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit. For example, one billing unit for a drug is equal to 10mg of the drug in a single use vial. A 7mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.”
Keeping your organization in tune with frequent coding changes can be a tough task for compliance to maintain. To make sure you’re not only compliant but also receiving proper payment, it’s vital that everyone in your organization is up-to-date on how to use the JW modifier. We can train your pharmacy, nursing, coding, billing and IT staff—anyone responsible throughout the process of care—on the details, and streamline communications between pharmacy and billing. The experts at Revenue Cycle, Inc. are here to help—from compliance and staff education to documentation and coding reviews. For more information regarding RCI’s services, please contact our consulting team at 512-583-2000 or firstname.lastname@example.org.