Are you billing for flu and pneumonia vaccines?

Your staff is likely providing flu and pneumonia vaccines to residents; however, an increasing number of providers are not taking advantage of this cost based reimbursement opportunity. Click here for a brief Quick Reference Guide published by CMS, summarizing the billing codes, allowed frequency of administration, and other frequently asked questions.

Some points to keep in mind to help you maximize reimbursement:

    1. Shots can be purchased in bulk (23 shots in one vial). If you expect to administer the shots in high volume, take advantage of bulk pricing.
    2. Instruct billers to use both codes when billing (one for the actual vaccine and the other for the nursing administration portion).
    3. Under the consolidated billing rule for skilled residents, vaccines are excluded. Be certain that your staff is billing these charges on a separate claim form.
    4. The maximum allowable amount is your friend! Log into your Medicare online system to find the percentage (determined by locality – zip code) to calculate your maximum allowable amount. You want to ensure you are charging this amount.
    5. When a resident receives both the flu and pneumonia vaccines, both administration codes should be reported (G0008 & G0009). Medicare will pay both administration fees if the resident receives both the flu and pneumonia shot on the same day.
    6. There are two ways of submitting vaccine claims to Medicare: Roster Billing and individual UB04 claims. Which method is your staff using?
    7. If you provided flu and pneumonia vaccines in the past year but didn’t bill them, you can still do so. Dates of service of less than 365 days can still be paid by Medicare.
    8. Don’t wait until flu season to educate your staff. Upon admission, each resident is asked when he or she last received the flu or pneumonia shot.
    9. If the resident has an HMO or Medicare Advantage Plan rather than Medicare B, contact those companies individually to inquire about their policy for reimbursement of vaccinations.

PointClickCare (PCC) users:  We have a proven way to streamline the vaccine billing process, in PCC, by maximizing the use of the software. Our process saves a lot of time and frustration of creating claims.  Contact us today to learn more.    Regardless of software, our Revenue Cycle Group can provide assistance with roster billing and other services you may require.  Contact your HW Healthcare Advisor if you have any questions or require any assistance.

PBJ Submission Due Tomorrow, February 14, 2017!

As a quick reminder, the second quarterly Payroll Based Journal (PBJ) submission is due February 14, 2017.  The submission must cover hours worked for the period from October 1, 2016 through December 31, 2016.  CMS recently added a feature to Nursing Home Compare showing whether facilities submitted data for the first quarterly submission due in November.  While most Ohio facilities show they have submitted data, some facilities have yet to make an acceptable submission.  For the November submission, CMS simply asked providers to make a good faith effort to get their submissions into the PBJ system.  For the current quarterly submission due tomorrow, however, we highly recommend your submission be accepted by the deadline tomorrow.