New Modifiers Ahead!
CMS is limiting providers’ reimbursement once again. Effective January 1, 2019, CMS will be implementing new modifiers and changing current modifiers already in place. The Advis Group wants to ensure providers are ready for these changes because most changes impact reimbursement. Providers should confirm with their Revenue Cycle and IT team that the correct modifiers are reported.
CMS will continue the use of the “PO” modifier to identify all excepted (“grandfathered”) off-campus hospital outpatient locations when implementing site neutral reimbursement. These locations will be paid at 70% of the OPPS rate in 2019, and 40% of the OPPS rate in 2020 and beyond, for clinic visits coded under G0463. Note: This rule will not impact (1) on-campus provider-based departments located within 250 yards of the main hospital; (2) off-campus provider-based departments located within 250 yards of a remote hospital location; or (3) any hospital dedicated emergency departments.
CMS created the new “ER” modifier, requiring that it be reported with every claim line for outpatient services furnished by an off-campus provider-based emergency department. At this time, the purpose of the modifier is to develop data assessing the extent to which OPPS services are shifting to off-campus provider-based emergency departments. The “ER” modifier will not have any reimbursement impact at this time.The Advis Group recently confirmed with CMS that the “ER” modifier does not apply to provider-based departments within 250 yards of a remote inpatient location of the hospital.
CMS announced the continued use of the “JG” modifier and reduced payment rate for 340B drugs. Beginning in CY 2019, the ASP – 22.5% 340B reduction will extend to non-excepted off-campus provider-based locations.
For any questions regarding the new modifiers, or for organizational assistance with any other health care regulatory or operational matters, please contact The Advis Group by calling (708) 478-7030. For future alerts and information please subscribe here.