Medicare Compliance & Reimbursement

You can append modifier CR for more than just natural disasters.

In catastrophic situations like Hurricane Harvey, Section 1135 of the Social Security Act authorizes the HHS Secretary to waive or modify certain Medicare, Medicaid, CHIP, and HIPAA requirements. These basics cover the essentials you’ll need to submit claims after disaster strikes.

Why: HHS allows these waivers in order to better monitor how payers process claims in these uncertain circumstances, explains Dawn Rogers, coding specialist at Caduceus Inc. in Jersey City, New Jersey.

However your coding, and modifier usage, could change when reporting services for patients affected by the disaster. CMS created modifier CR (Catastrophe/disaster related) “in order to track and facilitate claims processing for disaster victims,” indicates Rogers.

“In accordance with CR 6451, use of the ‘DR’ condition code and the ‘CR’ modifier are mandatory on claims for items and services for which Medicare payment is conditioned on the presence of a ‘formal waiver’ including, but not necessarily limited to, waivers granted under either Section 1135 or Section 1812(f) of the Act,” states MLN Matters release SE17020 revised from the original on Sept. 5, 2017 about Medicare claims in the aftermath of HurricaneHarvey.

Nuts and bolts: When a Section 1135 waiver is official, CMS will notify payers of the event and provide them with the following information, says Mary I. Falbo, MBA, CPC, President and CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pennsylvania:

• A summary of the Secretary’s declaration (if any);
• Specific geographic areas affected by catastrophe/disaster declarations;
• Specific instructions on which formal/informal waivers are permitted for use;
• The beginning and end dates for use of the CR modifier and;
• Other uses of the modifier that will be mandatory for the particular catastrophe/disaster.

While you might think any service related to a disaster would qualify for modifier CR, there are some very specific parameters that must be met before using the modifier. You can only use the modifier in clearly defined catastrophe/disaster situations, confirms Falbo.

Of interest: The type of disaster doesn’t really matter. While the above involves weather, you might also use the CR modifier “for mass shootings, bombings, explosions; anything that would meet the criteria for a Section 1135 waiver,” explains Rogers. Once the President and Secretary make the Section 1135 waiver official, you should report modifier CR along with any services for patients affected by these catastrophes, she adds.

Tip: Keep an eye out for these CMS announcements on your MAC’s website or listserv, so you’re on the same page as they are when reporting your disaster claims.

Resources: For more information about the 1135 Waiver policies, visit:

• Emergency-Related Policies & Procedures Implemented With A 1135 Waiver: www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/MedicareFFS-EmergencyQsAs­1135Waiver.pdf.
• Emergency-Related Policies & Procedures Implemented Without A 1135 Waiver: www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Consolidated_Medicare_FFS_Emergency_QsAs.pdf.