Medicare Compliance & Reimbursement

Tip: Submit CMS-1500 for mass immunization claims.

Preventive vaccinations have become almost as popular as annual wellness visits to fend off illness. Due to their popularity, many Medicare providers and suppliers offer them en masse or in "flu clinics," administering mass immunizations over the course of the designated flu season. With large numbers of beneficiaries being vaccinated around the same time, CMS gives providers the option to utilize roster billing.

Nuts and bolts: Roster billing makes the claims process more efficient for providers who do large group influenza vaccinations annually. To apply for roster billing through Medicare - which is ongoing with no specific sign-up dates - you must be licensed in the states where you operate your practice, enroll with your A/B MAC, and submit all your bills to your local contractor, suggests MAC NGS Medicare in its fact sheet from a preventive services webinar.

"To enroll in the Medicare program solely as a Mass Immunization Roster Biller, individuals should complete Form CMS-855I and groups should complete Form CMS-855B," says CMS in an MLN Booklet on the subject. If you choose to sign-up, remember that you must choose the provider specialty type as 73 - mass immunization roster biller - for the application to be accepted.

Don't Mix and Match Vaccines on the Same Roster Bill

Influenza and pneumococcal immunizations are the only vaccine-types accepted through roster billing, but they cannot be claimed together. "You cannot mix vaccines on the same roster bill," notes Michelle Coleman CPC of Part B MAC NGS Medicare's provider outreach and education group in a webinar on the subject. "You must use separate claims and roster bills for influenza and pneumococcal or the claims will be rejected."

Tip: You can still use the CMS-1500 form, but it will be filled out differently than you would for a single immunization claim with changes to the line items that are appropriate and relate to a large, group claim. "Some MACs let you develop your own roster forms that contain the minimum data, but others do not," the guidance suggests. Check with your MAC before submission to see your roster-form options.

Centralized billing: Another option for mass immunization providers, who operate in three or more states, is centralized billing, which allows providers to send all their claims to one designated MAC. If you "operate in at least three payment localities where three different MACs process claims," you may be eligible for this streamlined billing process as long as you are licensed in the states where the shots are given, indicates CMS in its guidance. The enrollment process takes upwards of 8-12 weeks and must be completed using the CMS-855 enrollment form "by June 1 of the year you plan to begin centralized billing," the agency says.

Resource: For a closer look at what roster billing entails, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Mass_Immunize_Roster_Bill_factsheet_ICN907275.pdf.