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:
- Administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine
- 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.
- 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.
- 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.
- 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.
- Use the ICD-10 diagnosis code Z23 on the claim.
- 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:
- The appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration.
- 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:
- Bill the HCPCS Level II code (M0201) only one time for the additional payment rate
- 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:
- A roster bill containing the appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration.
- 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:
- The vaccine isn’t related to your patient’s terminal condition
- 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:
- Your Medicare patients have other insurance, such as employer health insurance or coverage through a spouse’s employer health insurance
- 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.
- Their health insurance doesn’t include the COVID-19 vaccine administration fees as a covered benefit
- 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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