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FAQs on Healthcare Billing Services for Covid-19 Vaccination

Are you aware of the healthcare billing services that providers need to undergo for Covid-19 vaccinations? Healthcare professionals are supposed to send their claims for the administration of the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) for payment. This article provides answers for most of the frequently asked questions on healthcare billing services for Covid-19 vaccination.

Is there any Out-of-Pocket Cost for the Patients? Do Healthcare Billing Services Support that?

  • Patients are allowed to have Covid-19 vaccination without a healthcare professional’s supervision. They aren’t supposed to pay anything for the vaccine.
  • If at all you want to participate in the CDC Covid-19 Vaccination program, one must follow the below:
  1. Administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine
  2. Vaccinate everyone, including the uninsured, regardless of coverage or network status

Healthcare billing services cannot support for:

  • Balance bill for COVID-19 vaccinations
  • Charge your patients for an office visit or other fee if COVID-19 vaccination is the only medical service given
  • Require additional medical or other services during the visit as a condition for getting a COVID-19 vaccination.

How do healthcare billing services bill for administering Covid-19 Vaccination?

  • You must be a Medicare-enrolled provider to bill Medicare for administering COVID-19 vaccines to Medicare patients.
  • You can also bill on single claims for administering the COVID-19 vaccine and submit claims on a roaster for multiple patients at a time.
  • If you choose the Place of Service code for your Part B claims, you will have to consider where you provided the vaccine carefully.
  • Roster billers should use POS code 60 regardless of provider type, even if you’re not a mass immunization roster biller.
  • Acknowledge and document if you administer additional vaccine doses on or after August 12, 2021, consistent with the FDA’s updated emergency use authorizations.
  • When the government provides COVID-19 vaccines at no cost, you must only bill for the vaccine administration. Healthcare billing services need not include the vaccine codes on the claim when the vaccines are free.
  1. It would help if you administered the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine.
  2. If you want to administer the vaccine for free, you don’t have to submit a claim to Medicare, Medicaid, or another insurer. But, you can’t charge your patients or ask them to submit a claim to Medicare or another insurer.
  3. If you get government funding to help pay for administering the COVID-19 vaccine, one can still submit a claim to Medicare for administering the vaccine.
  4. Use the ICD-10 diagnosis code Z23 on the claim.
  5. Until the PHE ends, you should only include modifier CR on your claim if you administer the COVID-19 vaccine at a temporary location that isn’t considered your actual practice location.

How to Bill for the Additional Payment for Administering the Vaccine in the Patient’s Home?

  • It would be best if you used both of these:
  1. The appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration.
  2. The HCPCS Level II code M0201 for the additional payment amount for administering the COVID-19 vaccine in the home.
  • You should only bill for the additional in-home payment amount if the sole purpose of the visit is to administer a COVID-19 vaccine. You shouldn’t bill for the additional amount if you provide and bill Medicare for another service in the same home on the same date.
  • Healthcare billing services must bill for the additional payment amount only once per home per date of service. If you administer the COVID-19 vaccine to more than 1 Medicare patient in a single home on the same day, you should:
  1. Bill the HCPCS Level II code (M0201) only one time for the additional payment rate
  2. Bill for each dose administered using the appropriate CPT code for the product and dose-specific COVID-19 vaccine administration.
  • When you submit roaster bills for administering the COVID-19 vaccine in the home, you are supposed to roaster bills. They are:
  1. A roster bill containing the appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration.
  2. A second roster bill contains the HCPCS Level II code (M0201) for additional in-home payment.

How do healthcare billing services bill Medicare Advantage Patients?

  • You must ask your Medicare Advantage patients for their Original Medicare cards. All Medicare patients will have a red, white, and blue Medicare card with an MBI, including those enrolled in a Medicare Advantage Plan.
  • You’ll require your patients’ first names, last names, dates of birth, and SSNs. You can also lookup the MBI for Medicare patients, including those enrolled in a Medicare Advantage Plan.
  • For Part A and Home Health and Hospice (HHH), claims include Condition Code (CC) 78.

How to Bill for Hospice Patients?

  • For hospice patients under Part B, healthcare billing services or providers must include the GW modifier on COVID-19 vaccine administration claims if either of these applies:
  1. The vaccine isn’t related to your patient’s terminal condition
  2. The attending physician administered the vaccine

Explain Coordination of Benefits & Medicare as Secondary Payer.

  • Prior to the submission of Medicare claim for administering COVID-19 vaccines, you must find out if:
  1. Your Medicare patients have other insurance, such as employer health insurance or coverage through a spouse’s employer health insurance
  2. Medicare pays first or second.

What if Patients don’t have Medicare?

  • Patients without health insurance can also get the COVID-19 vaccine and administration at no cost. If you vaccinate these patients, you can request payment for administering the vaccine through the HRSA Covid-19 Uninsured Program.
  • Healthcare providers administering the vaccine to underinsured individuals can also request reimbursement for the administration of the COVID-19 vaccine through the same program.
  1. Their health insurance doesn’t include the COVID-19 vaccine administration fees as a covered benefit
  2. Their health insurance covers the COVID-19 vaccine administration but with cost-sharing.

What Are Valid Types of Bills for Roster Billing?

  • 12X, Hospital Inpatient
  • 13X, Hospital Outpatient
  • 22X, Skilled Nursing Facility (SNF)-covered Part A stay (paid under Part B) & Inpatient Part B
  • 23X, SNF Outpatient
  • 34X, Home Health (Part B Only)
  • 72X, Independent and Hospital-based Renal Dialysis Facility
  • 75X, Comprehensive Outpatient Rehabilitation Facility
  • 81X, Hospice (Non-hospital)
  • 82X, Hospice (Hospital)
  • 85X, Critical Access Hospital

There are many regulations and policies involved in healthcare billing services for Covid-19 vaccinations. But everything has a process to follow. All of them may not be the same, but each and everything must be monitored perfectly.

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