Eli's Hospice Insider

Published on Wed Oct 16, 2013 PDF

Billing flu shots for your 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 Services 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 Hospice Insider, Vol. 6, No. 8).

“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.

“These vaccines should be billed to the local A/B Medicare Administrative Contractor (MAC) on the 1500 claim form and not on the UB-04 claim form,” Palmetto advises in a recently posted question-and-answer set from its July 16 Ask the Contractor Teleconference. “Payment is made using the same methodology as if they were a supplier.”

Do this: “Hospices that do not have a supplier number should contact their local A/B MAC to obtain one as these vaccinations would not be billable under their current hospice provider number,” Palmetto instructs.

According to the Medicare Claims Processing Manual, “payment is made using the same methodology as if they were a supplier,” Palmetto says on its website. Enrollment in Medicare Part B is separate from the agency’s Part A enrollment to become a hospice provider, Palmetto elaborates. 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 MACs’ 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:

• 90656 — Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use — $12.398 (exactly the same as last year)
• 90686 — Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use — $19.409 (new code this year so comparison values aren’t available).

Note: More on CMS’s flu shot pricing is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8433.pdf. CR 8098 is at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1217OTN.pdf.