We get asked a lot about vaccines in the office. I’ve often held off doing them – one of my concners has been that reimbursement from certain carriers does not cover my cost to purchase the vaccine.
For the most part, the influenza vaccine has not been a problem. Last year, I only purchased a few to see how it would go. This year…we’ve held one flu clinic, and I’m still giving vaccines daily. I’ll probably hold one or two additional “clinics” before the season is over.
AAFP has published an article on how to code for these vaccines so you will not loose revenue. Timely I’d say.
 Coding Flu Shots: Immunize Against Lost Revenue
{ 4 comments… read them below or add one }
I have a question which I did pose to Barbara, but perhaps others reading this might have something to add. I noticed on the AAFP bulletin on coding for flu shots, they do not mention what they are reimbursed. I was told by a Blue Cross carrier, that even if I did 100 flu shots, and this was a flu clinic, and not individual office visits, that each individual would have to pay their 25.00 co pay prior to Blue Cross reimbursing the balance. This was a surprise to me as well as to some of the individuals that are going to get the flu shot. We opted to do a cash only clinic at 15.00 a flu shot, as this will cover the vaccine, and supplies . We are not going to put through any claims, and have decided since I have a new office, meeting 100 prospective new patients is worth the absence of additional revenue. However I wonder if others had heard differently about the insurance carriers reimbursing. I gave the information that I would only be using a V code for the flu vaccine, and the CPT specific to the flu vaccine, and the administration code. There would be no 99211 or other office visit codes. But the insurance company still said they had to pay a 25.00 co pay. This really did not make sense, as I thought a co pay was for an “office visit” charge. Carla Anderson, Healing Presence Family Practice/Oregon
Carla,
An additional thought…call around to some of the other insurance carriers you have contracts with and ask them the same question. I still think this particular Blue Cross carrier was either in error, or crazy.
We called all of ours since this was the first year we were doing large numbers of flu immunizations. All of them said they were covered, and all said no co-pay if that was all we were doing (ie, flu clinic).
As far as reimbursement – it’s easy enough to get the Medicare reimbursement for your area. For the most part, I just assume that commercial will reimburse at a better rate (and DSHS/managed care – less). In our case, commercial reimbursed about $10 more (I think).
I look forward to hearing the experience of others, especially across state lines…
Barbara (WA)
Barbara,
We are scheduled to do this next Wednesday, the 28th, for about 100 employees. We will have all the screening questionairres and vis forms handed out a couple days before, as this will give us a roster and number to give vaccine to. Then we will have all supplies on the go, so we can just check id, with screening page, give the shot, and fill out a business card, with the flu shot info and go.. We are bringing about 150 business cards, and a small emergency kit with benadryl and epi , ammonia, bp cuff.
But regarding the insurance, I will call again.Maybe my local blue cross. But when you chart, do you chart a note, or just scan in their screening/consent form, and then log in on vaccine info the site, lot, expiration, etc.? Do you fill out an entire demographics page on amazing charts? Because if we do that on 100 or so, that is a lot of work.. I would appreciate hearing your system, but I will call again on Monday, because if it means that the patients pay zero, and we get 30. 00 or more per person, that is an extra 1500.00 or so, which is worth it!
Hi Carla,
When I did my flu clinic…it was in my office and the majority of patients were all ready established and thus already in Amazing Charts.
For people who were not already established (mostly family members of patients) and who wanted the vaccine, I had them fill out a patient registration and sign the financial policy. They also, like everyone else had to sign a consent form after receiving and reading the VIS. Yes, we scanned in the consent along with other documentation including insurance card and photo ID.
It really depends on how you want to do this and how you want to bill.
I know with Medicare you can do roster billing and perhaps you can do that with Blue Cross. However, we actually found it easier to just submit bills individually using Office Ally.
Let me know if you have more questions. Good luck next week and keep us posted!
Barbara