Disasters Happen: What Does Your Medicare Contractor Want You to Do Next?

medical billing when disaster strikes

I’m feeling pretty lucky. When Hurricane Matthew blew through my town a couple of weeks ago, the worst I experienced was a three-day power outage and a flooded basement. Plenty of others nearby faced much worse. My town is several hours from the coast, so the degree of destruction took most of us by surprise, proving that you can’t make assumptions about when a natural disaster will strike.

Once my power (and therefore Internet) returned, I noticed emails from different payers with alerts about how Hurricane Matthew was affecting claims and advice on what to do. These emails were a good reminder that medical practices need to have preparations in place so they have a plan to follow when emergencies occur.

Improve Your Post-Disaster Know-How With These FCSO Tips

First Coast Service Options (FCSO) added a page in its Disaster Information section for its Florida Medicare providers that offers tips on handling issues presented by Hurricane Matthew. If you aren’t under FCSO, you can still get some good advice and get motivated to check out what your own payers have to say about handling claims after a disaster.

Temp address: If you can’t get mail at your usual location, you can set up a temporary address for payments from FCSO to go to. Your disaster preparation plan can include keeping a record of options for your alternate address and the contact information (such as payer phone number) required to set up the temporary change. Keep your plan in a safe place (or places) that you can get to when you need it.

Paper claims: FCSO also reveals some good news and bad news about swapping to paper claims. Good: HIPAA regulations allow paper claims when natural disaster strikes. Not as good: FCSO reminds its providers that payment for paper claims won’t be as speedy as electronic claim payment. Instead of issuing payment in 14 days, FCSO says you can expect clean paper claims to be paid more than 27 days after FCSO gets the claim. So if you expect to be able to submit electronic claims within about a week of the natural disaster, you may want to just hold on to any claims until then.

Appeal extension: When it comes to any appeals you have pending, you may be glad to know that FCSO says you can claim hurricane recovery as a reason to ask for a time extension.

Records: If you got hit so hard that you lost medical records, FCSO advises reconstructing what you can for any partially destroyed records. You do need to mark the face of the record with this note, though: “This record was reconstructed because of disaster.”

Review These Resources Before It’s Too Late

If you participate in Medicare, be sure to check out the emergency Q&A docs provided by CMS about policies and procedures that apply without a waiver and those that require a waiver to be granted.

And, speaking of waivers, if you’ve been wondering when to use modifier CR (Catastrophe/disaster related), be sure to read MLN Matters MM7156 about the limited circumstances that make use of this modifier appropriate. You should append it only when Medicare payment relies on the presence of a formal waiver.

How About You?

Do you have any disaster prep tips to share? Have you found that payers work with you to handle issues that come up when disaster strikes?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

, , , ,

Leave a Reply