Medicos is trying to clarify its options in the delivery of vaccines to the public.The H1N1 "don't -call-it-swine" flu of 2009 is a good example of our problem. The government vaccine programs have become a nightmare of conflicting reports, unpredictable policy shifts, non-reimbursable administrative mandates, and constant shortages of one vaccine or another. If Medicos cannot receive vaccines through the federal Vaccines For Children[VFC] program, Medicos must develop a contingency plan to purchase its own vaccines, since the health of the patients must be preserved. Below, our billing department states that medicaid programs have prohibited payment to physicians who buy these vaccines and give them to patients.
There are two major groups to consider--adults and children[0-18]. Tetanus-diphtheria, adult pneumonia, flu, and HepB have always been a service available to adults at Medicos and elsewhere. I never heard of failure to reimburse for these vaccines even from medicaid. Have we been paying for these vaccines and giving them for free?
For example, all adults over age 60 and patient with lung disease are recommended to have pneumonia vaccine. We have never sent these adult patients to the department of public heath for these vaccines. They are given in the office and are billed in the usual way. Am I wrong? I assume that the rest of the discussion applies only to children. Correct?
Amy from billing writes
THE VACCINE REIMBURSEMENTS ARE DENIED BY BOTH TENNCARE PLANS (BLUECARE & AMERICHOICE). THEY ONLY PAY FOR THE ADMINISTRATIONS EVEN IF PRIVATE STOCK. LAST YEAR WE HAD 4 PLANS AND THEY EACH WERE DIFFERENT. NOW WE HAVE TWO PLANS AND THEY ARE BOTH ALLOWING/DISALLOWNG ABOUT THE SAME PROCEDURE CODES.
AMY--Billing
Index--vaccine policies
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