Updated on: November 29, -0001

DEVELOPING: CMS Delays Mandatory JW Modifier

By Robin Zweifel, BS, MT(ASCP) and Courtney Boss, CPC, BS
Original story posted on: June 8, 2016

  The mandated implementation of the JW modifier requirements will now be pushed back from July 1, 2016 until Jan. 1, 2017, according to an announcement made on Tuesday by a representative from the Centers for Medicare & Medicaid Services (CMS) during the agency’s open door forum.

Many stakeholders, including the American Hospital Association (AHA) advocated for a delay mentioning “the need for extensive upgrades to electronic health record systems and provider training and patient safety concerns with recording two amounts for a single administration of medication.”

Even though the statement has not been placed in writing and is therefore unofficial, it does offer solace to hospitals and other healthcare organizations that have to adequately prepare to meet the new requirement. An official transmittal citing the delay is expected to inform providers.

Hospitals and physicians should be cautious and not discontinue any steps currently underway for reporting the JW modifier and ensuring that the discarded amount from a single-use vial or single use package is adequately documented in the patient medical record.  Until official notice is issued in writing by CMS, providers should continue as though July 1 remains the implementation date. 

Even if the delay becomes official, it is best to act proactively and be prepared for the now assumed January 1 implementation.

JW Modifier: Looking Back

On Jan. 1, 2008, CMS issued a manual update to clarify the use of the JW modifier via transmittal 1478. Implementation of the JW modifier was set for April 14, 2008 and effected all drugs except for Competitive Acquisition Program (CAP) drugs for Part B. Any unused and discarded portion of a single dose drug or biologic vial or package that is not considered a CAP drug, may have been required to use the new modifier in order to be reimbursed for that unused portion.

CMS mentioned that physicians, hospitals, and other providers should schedule patients in the most clinically appropriate and efficient manner possible. CMS further stated that this scheduling practice would effectively reduce unused portions of multi-dose vials and packages, particularly because transmittal 1478 clarified that unused portions of multi-use vials are not eligible for payment of waste.

Between 2008 and 2016, Medicare contractors had the discretion of whether to require use of the modifier.  However, on April 29th CMS transmittal 3508 was released - and - was soon replaced by transmittal 3530 on May 24, 2016. Transmittal 3530 issued an implementation date of July 1, 2016 for the required use of the JW modifier to “effectively identify and monitor billing and payment for discarded drugs and biologics” from a single-use vial or single-use package.  The transmittal also emphasized the requirement for providers to document the unused portion of the drug or biologic within the patient medical record.  Any unused portion of a drug or biologic, except CAP drugs, should be billed on a separate line item from the used portion with the JW modifier append. Meaning that only the unused portion carries the JW modifier.

About the Authors

Robin Zweifel is the senior vice president of revenue capture services for Panacea Healthcare Solutions Inc. Robin’s areas of expertise include clinical laboratory and chargemaster management, as well as infusion and pharmacy regulatory compliance.

Courtney Boss, CPC, BS, is a healthcare consulting analyst with Panacea Healthcare Solutions. Courtney supports the coding and documentation and revenue capture departments by providing project assistance, auditing services and technical expertise.

Contact the Authors

rzweifel@panaceainc.com

cboss@panaceainc.com 

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Resources

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1478CP.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3530CP.pdf