Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to Medicare-enrolled providers concerning reporting changes in enrollment information.

Failure to comply with the requirements to report changes in Medicare enrollment information could result in the revocation of Medicare billing privileges.

All physicians, non-physician practitioners (e.g., physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, registered dietitians or nutrition professionals) and physician and non-physician practitioner organizations must report the following changes in their enrollment information to their MAC via the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or the CMS 855 paper enrollment application within 30 daysof the change:

  • a change in ownership;
  • an adverse legal action; or
  • a change in practice location.

Providers must report all other changes to their MAC within 90 daysof the change.

Supplier of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) must report any changes in information supplied on the enrollment application within 30 days of the change to the National Supplier Clearinghouse (NSC).

Independent diagnostic testing facilities must report changes in ownership, location, general supervision and adverse legal actions to their MAC either online or via the appropriate CMS-855 form, within 30 calendar days of the change. They must report all other changes to enrollment information within 90 days of the change.

All providers and suppliers not previously identified must report any changes of ownership, including a change in an authorized or delegated official, within 30 days; and all other informational changes within 90 days.

The Centers for Medicare & Medicaid Services (CMS) has issued a change in policy regarding the use of the -JW modifier for discarded Part B drugs and biologicals.

The -JW modifier identifies "Drug amount discarded/Not administered to any patient."

Effective Jan. 1, 2017, providers will be 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

The -JW modifier is not used on claims for CAP drugs and biologicals.

CMS indicated it is revising this policy to require the uniform use of the -JW modifier for all claims with discarded Part B drugs and biologicals in order to more effectively identify and monitor medical billing and payment for discarded drugs and biologicals.

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