Practice Management Alert

Here’s why your practice should stay alert if a catastrophe happens nearby.

The specter of disasters and catastrophes spans the entire nation. As everyone knows, disaster can strike anyone, anywhere, and at any time.

If disaster strikes and you have to treat patients, take special care to code accordingly.

Reason: Your coding, and modifier usage, could change when reporting services for patients affected by the catastrophe/disaster. In order to expedite and strengthen your claims for patients in disaster areas, the Centers for Medicare & Medicaid Services (CMS) created modifier CR (Catastrophe/disaster related).

Check out this info on what has to happen before you can start using modifier CR, and stay safe if a catastrophe occurs near your practice.

President, HHS Must Make Declarations Before You Use CR

While you might be tempted to 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 Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pa.

In disaster/catastrophe situations, Section 1135 of the Social Security Act authorizes the Secretary of the Department of Health and Human Services (HHS) to waive or modify certain Part B Medicare, Medicaid, Children’s Medicaid (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) requirements. 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, N.J.

Caveats: Before HHS can invoke the 1135 waiver, and you can use modifier CR, two events must occur:

1. The president must declare an emergency or disaster under the Stafford Act or the National Emergencies Act.
2. The HHS Secretary must declare a Public Health Emergency (PHE) under the Public Health Service Act.

According to Rogers, some of the most recent declarations to meet the above parameters are:

• Floods in North Dakota (2011);
• Storms and tornadoes in Missouri (2011);
• Tropical Storm Lee in New York (2011); and
• Hurricane Sandy in New York and New Jersey (2012).

Takeaway: The type of disaster doesn’t really matter. While all of the above scenarios involve 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.

To see the most recent Section 1135 waiver, for Hurricane Sandy, go to: https://www.cms.gov/About-CMS/Agency-Information/Emergency/Signed-Renewal-of-Determination-January-25-2013.pdf.

Note Payer Notices on CR-Relevant Events

When a Section 1135 waiver is official, CMS will notify payers of the event and provide them with the following information, says Falbo:

• 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.

Best bet: Keep an eye out for these CMS announcements to payers, so you’re on the same page as they are when reporting modifier CR.