09FluGuide

09FluGuide - 2008-2009Immunizers Question &...

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Unformatted text preview: 2008-2009Immunizers Question & Answer Guideto Medicare Coverage ofInfluenza and Pneumococcal VaccinationsSteps to Promoting WellnessAdult ImmunizationsThe issues involved in Medicare billing and administration can be complex and may vary state to state. For this reason, we recommend that you contact your local fiscal intermediary/AB MAC, carrier/AB MAC (Part B), or the Centers for Medicare & Medicaid Services Regional Office for more detailed information.Centers for Medicare & Medicaid ServicesMedicare Influenza and Pneumococcal Vaccination Benefits2008-2009 Immunizers Q&A Guide to Medicare CoverageSeptember 25, 2008Table of ContentsA.Introduction...4PurposeBackground of Medicare Pneumococcal and Influenza VaccinationBenefitsACIP GuidelinesSummary of ACIP Guidelines (Pneumococcal/Influenza)Who Should BE Vaccinated?Who Should NOT Get the Influenza Virus VaccineOther Vaccination Recommendations Use of Live, Attenuated Influenza Vaccine (LAIV)Contacts/Resources for More InformationB.Coverage Policy......13Coverage CriteriaEligibilityMedicare Requirement for ConsentWho Can BillWho to BillPhysician PresenceFrequencyHome Health AgenciesHHA Mass BillersC. Payment Policy...21Medicare Vaccine/Administration PaymentCurrent Administration and Vaccine Reimbursement RatesCollecting PaymentBilling ProceduresHome Health AgenciesHIPAAPart A Intermediary/AB MACPart B Carrier/AB MACDiagnosis & Procedure CodesD.Mass Immunizers/Roster Billers.38DefinitionEnrollment RequirementsBilling Procedures2Hospital Inpatient Roster Billing3Table of Contents ContinuedE. Centralized Billing..46F.Managed Care.50G.Terms and Definitions...524A.IntroductionPurposeThis document addresses immunizers commonly asked questions about the administration of influenza and pneumococcal vaccines to Medicare patients. It also includes questions and answers that are particularly relevant to the 2008-09 influenza immunization season.The following information will be useful for immunizers; however, the issues involved in Medicare billing and administration can be complex and may vary from state to state. For additional, detailed information, contact your local fiscal intermediary, AB MAC, carrier (Part B), or the Centers for Medicare & Medicaid Services (CMS).The following sections provide a summary of the current recommendations of the Advisory Committee on Immunization Practices (ACIP) as they relate to adult immunization; Medicare coverage and payment policy; requirements for mass immunizers and centralized billing; and a brief discussion of managed care. In addition, a list of definitions is included....
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09FluGuide - 2008-2009Immunizers Question &...

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