Q: Can our agency bill Medicare for one skilled nursing visit to administer the flu vaccine if the patient is currently active, receiving other skilled services, and we get a physician’s order?
A: In 2002, the Centers for Medicare and Medicaid Services (CMS) determined it was not necessary for an agency to obtain orders to administer the flu or pneumonia vaccine to patients. CMS says an agency must establish a protocol for vaccination. The agency can receive payment from Medicare for the vaccines; however, CMS does not cover the cost of the visit.
If this patient is currently receiving other skilled services, the nurse can administer the vaccine during a skilled visit. A visit just to administer the vaccine not be billable. (Administration of the vaccine is not recognized as a reasonable and necessary service to treat a medical condition.) The nurse would need to document administration of the vaccine, per agency procedure.
An important reminder: Although no order is necessary for administration of the flu vaccine, it is still necessary to obtain an order for epinephrine, in the event that the patient might experience an allergic reaction. CMS instructions did not address this medication.
The audio conference on March 18 will address flu and pneumonia vaccine, along with best practices for diabetic foot care, preventing falls, and heart failure. Learn more about this educational session at — http://www.beaconhealth.org/item–A-Guide-to-Falls-Footcare-Flu-and-Failure–J031810A.html.
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November 22nd, 2010 at 1:32 pm
Our billing person says the Physician listed as primary on the 485 must also be the one who signs the 485, or billing will be denied. Often we have a change during cert periods when do we change the primary, immediately or at end of cert.