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Because of where they are administered, vaccines and their administration are not a great fit with a prescription drug benefit program. Part D is essentially an outpatient drug benefit based upon network pharmacies, providing access to Part D plans’ negotiated prices. And a vaccine is often administered in a physician’s or other provider’s office and has been typically treated as a medical benefit for billing and reimbursement purposes. With CMS requiring formulary coverage of non-Part B vaccines and reimbursement of vaccine administration fees as of Jan. 1, 2008, and as new vaccines come on the market with indications for use by Medicare beneficiaries, in-network access for Part D vaccines has become imperative. This new CMS vaccine requirement has led to numerous billing problems for Part D sponsors, since coverage and administration of vaccines must be handled by the Part D sponsor. But most physician practice management systems do not accommodate Part D billing, forcing beneficiaries to pay out-of-pocket for their vaccines and then submit paper claims to plans for reimbursement. Moreover, billing the Part D vaccine administration fee through the pharmacy claims system may not involve use of a single code, but instead may require system users to input information into different fields on the electronic pharmacy claim. Different Part D plans may require different inputs in order to appropriately bill and reimburse the fee. Hear valuable intelligence about CMS’s new vaccine coverage and administration billing requirements and options, plus strategies for billing vaccine administration fees. Learn how to cover and bill for vaccines correctly to avoid CMS sanctions and enforcement action. Topics include:
Andrea Serrate, CPA, is vice president of specialty and payer services for Poc Network Technologies, Inc (PNT) as well as managing partner for Specialty Services of America, LLC, a national health care consulting firm located in Phoenix, Arizona. While contracting with PNT’s partner, Dispensing Solutions Inc., Serrate was responsible for identifying and developing the business model for the eDispense Vaccine Manager. She previously held senior management positions with national health care organizations, including NovaCare and BMJ Medical Management, Inc. Moderator: Barbra Golub, JD, managing editor of Medicare Part D News.
Compliance officers, pharmacy directors, financial managers, legal counsel and physician leaders at:
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