Thank you both for your responses. I have posed the question to others and the consensus regarding the requirements for Medicare being secondary is vague at best. If anyone has located documentation, please share!
About the MH modifier, if it is still in use by 2021, will we, the furnishing provider be paid on claims showing MH? If there is no penalty, that would certainly make our lives easier! But then wouldn't everyone just use the MH modifier instead of going through all the pain of getting our referring physicians to comply?
I'm afraid all this AUC 'education' is negatively impacting us as we are the only facility in the area providing information about AUC compliance. Anyone else have a similar experience? And how did you overcome it?
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Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
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Original Message:
Sent: 01-09-2020 08:31
From: Gregory Wertz
Subject: AUC Questions
Vicki,
Upon being posed the same question and the ongoing lack of clarity on this question I had sent an inquiry through the CMS Imaging AUC at <ImagingAUC@cms.hhs.gov>. Below their response. As I understand that the validity of this type of ticketed response may certainly be reliable, I would be more comfortable finding additional supporting published literature that may better answer your question.
Subject: AUC when Medicare is a Secondary Payor
Does AUC/CDSM apply when Medicare is the Secondary Payor?
The Medicare AUC program requirements apply when Medicare is the secondary payor.
Thank you,
The CMS AUC Team
As far as the MH modifier's use in 2021, it is my hope that CMS will address any changes from the previous MLN Matters notification published in late November 2019 that defined this MH modifier and it's use in respond to AUC. It is my sense that it would be used beyond the 2020 "Educational and Operations" testing period to identify non-adherence of ordering providers to identify the 5% that may be subject to Medicare pre-authorization.
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Gregory Wertz MS
Director of Industry Research and Relations
MBMS, LLC
State College PA
(814) 203-0088
gwertz@mbms.net
Original Message:
Sent: 01-08-2020 12:09
From: Vicki Parikh
Subject: AUC Questions
Hi Everyone,
Does anyone know if Medicare is Secondary (to any insurance, including Auto/Work Comp), does a CDSM need to be consulted?
Also, we have a few outlier offices that are simply refusing to comply and return everything to us with MH written on. Will MH still be a valid modifier in 2021? Or is the bottom line, without proof of actual CDSM consultation by the referring physician office, outpatient radiology practices won't get paid?
Thanks for your help!
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Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
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