LUTZ BUSINESS INSIGHTS
Tis the (Flu) Season
AMY EVANICH, SENIOR HEALTHCARE CONSULTANT
With summer quickly winding down a topic of conversation for many is the upcoming flu season, particularly vaccinations. The high severity of the 2017-2018 season leaves healthcare institutions wondering what is in store for the 2018-2019 season. While the proper care of these patients remains the top priority, another aspect that should be analyzed annually is proper coding and billing for immunizations such as the flu shot.
Effective for claims processed with Dates of Service (DOS) on or after January 1, 2019, Medicare Change Request (CR) 10871 provides instructions for payment regarding influenza virus vaccine code 90689 (Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use) will be payable by Medicare. The short descriptor is VACC IIV4 NO PRSRV 0.25ML IM. This new code will be included on the 2019 Medicare Physician Fee Schedule Database file update and the annual Healthcare Common Procedure Coding System (HCPCS) update. The new influenza virus vaccine code 90689 is not retroactive to August 1, 2018. No claims should be accepted for influenza virus vaccine code 90689 between the DOS August 1, 2018, and December 31, 2018.
Inpatient Immunization Billing Tips:
- Condition code A6 is used to indicate services not subject to deductible and coinsurance
- All providers that bill the intermediary for influenza and pneumococcal vaccines report the administration under revenue code 771
- Medicare hospitals bill for the vaccines under bill type 12x for their inpatients and SNFs bill for the vaccines under bill type 22x
Outpatient Immunization Billing Tips:
- Bill types 131 or 851
- Revenue code 636 for the vaccine and 771 for the administration
Medicare Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC) Immunization Billing Tips:
- The costs of influenza and pneumococcal vaccines and their administration are separately reimbursed at annual cost settlement on the Medicare Cost Report
- There is a separate worksheet on the cost report to report the cost of these vaccines and their administration
- The patient pays no Part B deductible or coinsurance for these services
- When an RHC practitioner sees a patient for the sole purpose of administering these vaccinations, the RHC may not bill for a visit; however, the costs of the vaccines and their administration are included on the annual cost report and reimbursed at cost settlement
Mass immunizations (Flu shot clinic) Billing Tips:
- Must be enrolled with Medicare as a mass immunizer
- Outpatient services can be billed on a roster
- Roster billing is used if multiple beneficiaries are immunized on the same day
- Entities that submit claims on roster bills must accept assignment and may not collect any “donation” or other cost sharing of any kind from Medicare beneficiaries; however, they may bill Medicare for the amount not subsidized from their own budget.
- Rosters are submitted with a 1500 claim form
Take the time now to ensure your billing department is ready in order to confirm proper reimbursement. If you have questions, reach out to get them answered before the busy season of billing for vaccinations begins. It will be here before we know it – Tis the (Flu) Season!
Department of Health and Human Services (DHHS) (2018, August 3). Quarterly Influenza Virus Vaccine Code Update – January 2019. Retrieved August 9, 2018, from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4100CP.pdf
Department of Health and Human Services (DHHS) (2018, January). Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B. Retrieved August 8, 2018 from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf
ABOUT THE AUTHOR
AMY EVANICH + HEALTHCARE CONSULTING SENIOR
Amy Evanich is a Healthcare Consulting Senior at Lutz with over 10 years of professional experience in the Healthcare industry. She specializes in the areas of medical chart reviews, appeal preparation, Medicare regulation guidance, interpretation and education, and healthcare billing policies and procedures.
AREAS OF FOCUS
- Healthcare Reimbursement
- Audit Response Assistance and Appeal Preparation
- Medical Chart Review Including Medical Necessity
- Healthcare Billing
AFFILIATIONS AND CREDENTIALS
- Registered Nurse (RN)
- Bachelor of Science in Nursing (BSN), Clarkson College, Omaha, NE
- Master of Science in Nursing Health Care Administration (MSN), Clarkson College, Omaha, NE
- Nebraska Action Coalition, Leadership Team
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