Billing flu shots for your hospice patients may be harder than you’d think.
As flu season ramps up, so do hospices’ headaches about flu vaccinations. That’s because Medicare has implemented a new claims system edit that will not allow any other provider to get paid for a flu, Pneumococcal or Hepatitis B vaccination.
Background: In a transmittal released in May, the Centers for Medicare & Medicaid Ser-vices makes clear that vaccinations are a hospice’s responsibility. "These services are only covered when provided to hospice beneficiaries by their hospice provider," CMS says in CR 8908. "This Change Request (CR) updates Medicare systems to prevent non-hospice providers from providing vaccines to hospice beneficiaries" (see Eli’s HCW, Vol. XXII, No. 20).
"Hospices can provide the vaccines to those patients who request them, but in order to receive separate payment the hospice must be enrolled in the Medicare Part B program," HHH Medicare Administrative Contractor Palmetto GBA explains in a post on its website. "The vaccines cannot be billed to Medicare on the UB04 hospice claim."
According to the Medicare Claims Process-ing Manual, "services for the vaccines should be billed to the local A/B Medicare Administrative Con-tractor (MAC) on the Form CMS-1500," CMS says. "Payment is made using the same methodology as if they were a supplier. Hospices that do not have a supplier number should contact their local A/B MAC to obtain one in order to bill for these benefits."
Enrollment in Medicare Part B is separate from the agency’s Part A enrollment to become a hospice provider, Palmetto explains. The hospice has to enroll in Medicare Part B to obtain a Provider Transaction Access Number (PTAN) for Part B billing privileges. To obtain a Medicare Part B PTAN, the agency would need to complete a CMS-855B Enrollment Application, CMS-588 Electronic Funds Transfer (EFT) Agreement, CMS-460 Medicare Participating Physician and Supplier Agreement and a $532.00 (2013) application fee.
Tip: "The agency’s MAC which handles their hospice responsibilities may not be the local A/B MAC," Palmetto says on its website. "Home Health and Hospice MAC’s jurisdictions are not the same as an A/B MAC. Questions regarding the Medicare Part B enrollment should be directed to the local A/B MAC."
According to MLN Matters article MM8433, the Part B payments related to flu vaccines for adults, effective Aug. 1, are:
Note: More on CMS’s flu shot pricing is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8433.pdf.