June 30, 2016

ACR Radiology Coding Source™ May-June 2016

  • Medicare Opt Out Regulations Revised
  • CMS issued notice that all physicians and practitioners who signed a valid Medicare Opt-Out affidavit on or after June 16, 2015, will have that affidavit automatically renewed every two years. If a provider wishes to stop that renewal from occurring, they may do so by notifying all MACs with which they filed an affidavit at least thirty days prior to the start of the next opt-out period. Affidavits signed before June16, 2015, will expire two years after the effective date of their opt-out, and if practitioners wish to renew that affidavit, it must be done within 30 days after the current opt-out period expires. See MLN Matters article.
  • CMS Issues Coding Revision to NCD
  • On June 3, 2016, CMS issued Change Request (CR) 9631 containing coding revisions to a number of NCDs including NCD 220.4 – Mammography and NCD 210.3 - Colorectal Cancer Screening. Updated NCD coding spreadsheets related to this change request are available. See MLN Matters article MM9631 for a full list of affected NCDs.    
  • CMS Issues Update Limiting the Scope of Review on Certain Claims
  • For redeterminations and reconsiderations of claims denied following complex pre- or post-payment, or automated post-payment review, MACs and QICs must limit their review to the reasons the claim was initially denied. This change is for redetermination requests received by a MAC or QIC on or after April 18, 2016, and will not be applied retroactively. Existing procedures regarding claim adjustments for favorable appeal decisions will continue to be followed. See MLN Matters article SE1521 for further details.
  • JW Modifier Guidance Issued by CMS
  • Effective January 1, 2017, all claims with unused drugs or biologicals from single use vials and packages appropriately discarded must make use of the JW modifier. The JW modifier identifies “Drug amount discarded/Not administered to any patient.” Providers will be required to document the appropriate discarding of each single use drug or biological in the patients’ medical record when submitting claims. The JW modifier is not used on claims for drugs in the Competitive Acquisition Program (CAP). This change in policy is made to more effectively identify and monitor billing and payment for discarded drugs and biologicals. For more information see MLN Matters article MM9603 and the Medicare Claims Processing Manual, transmittal 3530 for further details.