Reimbursable Revenue-Don’t leave it “Sitting on the Table”!

It’s Flu Season!

Is your Business Office prepared?

Have they Billed and Collected the money?

You are most likely asking, “What are they talking about?’  My Business Office has nothing to do with Flu Season, except for maybe making sure that the Business Office staff get a Flu Vaccine.  Well, yes and no!  Your Business Office staff should definitely get a Flu Vaccine, however this should not be where their role ends.

Does your facility order and provide Flu Vaccines to residents during Flu Season?

Or the Pneumonia Vaccine during the year if not received within the last 5 years?

If so, your Business Office should be billing Medicare for these services. Medicare Providers are allowed to bill vaccines and their administrative costs to Medicare as a Part B Institutional claim for any resident who is eligible for Medicare Benefits. This includes residents currently receiving Medicare Part A Services in the facility.

NOTE:  (You must verify that all Part A Claims for the Dates Of Service which includes the date of vaccination has finalized prior to submitting Part B Vaccine Claim).

For Medicare Part B Claims billed with flu and/or pneumonia vaccines and the appropriate administration fees as the only charges on the claim, the Intermediary or A/B MAC and Medicare will allow the claim to bypass MSP verification and edits.  They will pay the claim, if it is a clean claim meeting the specifications outlined in The Medicare Billing Manual, Chapter 18 – Preventative and Screening Services, Section 10.0 through 10.3 which defines and explains the process.

For residents with Managed Care Replacement Plans/HMO Plans the Business Office must contact the plan and determine if the Vaccine and Administration Fee are covered Part B services.  If they are, you should bill the Insurance Plan for the vaccine and administration fee as a Managed Care Part B Claim.   For any resident currently receiving skilled services covered by the Managed Care/HMO Plan you should confirm with the plan if vaccines and administration fees should be billed conjointly with the skilled services claim (21x Type of Bill) or separately as a Managed Care Part B Claim.

You might be thinking this is all well and good for billing individual claims for Flu or Pneumonia Vaccines administered to an individual resident upon admission, but no way is this cost effective for doing mass immunizations for all of my residents during Flu Season.  WELL….. Don’t be so hasty!  After industry representatives expressed exactly that concern, Medicare developed a different acceptable method of billing these claims, known as “Roster Billing”.

The first step in “Roster Billing” is a facility must provide the Vaccines (Flu and/or Pneumonia Vaccine) to at least five beneficiaries on the same date.  The vaccines are entered on a Roster/Log and must contain at a minimum the following information

• Provider name and number
• Date of service
• Patient name and address
• Patient date of birth
• Patient sex
• Patient health insurance claim number
• Beneficiary signature or stamped “signature on file.”
• Admission date
• Admission type
• Admission Diagnosis
• Admission source code
• Patient status code.

NOTE: A stamped “signature on file” can be used in place of the beneficiary’s actual signature for all facilities that roster bill provided the provider has a signed authorization on file to bill Medicare for services rendered. In this situation, they are not required to obtain the patient signature on the roster.

The pneumococcal vaccine roster, in addition to the above information, must contain the following language to be used by providers as a precaution to alert beneficiaries prior to administering the pneumococcal vaccine.

Warning: Beneficiaries must be asked if they have been vaccinated with the pneumococcal vaccine.

• Rely on the resident’s memory to determine prior vaccination status.
• If the resident is uncertain if they have been vaccinated within the past 5 years, administer the vaccine
• If resident is certain that they have been vaccinated within the past 5 years, do not revaccinate.

The Roster/Log is then submitted an attachment to a Form CMS-1450 paper claim with the following information entered in the appropriate field location:

• The words “See Attached Roster” (Patient Name)
• Patient Status code 01 (Patient Status)
• Condition code A6 (Condition Code)
• Revenue code 636 tied to Vaccine HCPCS code (Revenue Code)
• Appropriate HCPCS (HCPCS Code for Flu Vaccine)
• Revenue code 771 tied to the Vaccine Administration HCPCS code (Revenue Code)
• The appropriate “G” HCPCS code for Vaccine Administration (HCPCS Code)
• “Medicare” (Payer, line A)
• The words “See Attached Roster” (Provider Number, line A)
• Diagnosis code ICD-10-CM – Use Z23 for an encounter for immunization.
• the provider’s own NPI to be reported in the NPI field for the attending physician

You are most likely thinking this still involves too much time and effort.  Again, Medicare addressed this concern and went one step further and incorporated an electronic claims submission option for providers. The directive titled “Electronic Roster Claims” is located in Section 10.3.2.3 of the Medicare Billing Manual, Chapter 8 and states:

“As for all other Medicare-covered services, AB MACs (A) pay electronic claims more quickly than paper claims. For payment floor purposes, roster bills are paper bills and may not be paid as quickly as EMC. If available, AB MACs (A) must offer free, or at-cost, electronic billing software and ensure that the software is as user friendly as possible for the influenza virus vaccine benefit.”

What this means is your Intermediary or A/B MAC should allow access to the “Roster Billing” feature within DDE or provide some other form of electronic data entry.  Most available industry billing software incorporates this option as well. You still need to develop and use the Roster/Log for administering and tracking vaccines given to residents.  The Roster/Log will be used by the Business Office Staff to enter and submit the claim electronically.  This Roster/Log will need to be kept and maintained in the same manner as all other clinical documentation.

This is reimbursable revenue you don’t want to leave sitting on the table.

SNF-Solutions can assist you in your efforts to capture this money by providing training and developing Facility Policies and Procedures.