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Billing of Influenza Vaccinations in a Pediatric Practice

September 27, 2012 in Uncategorized by support Team  |  Comments Off on Billing of Influenza Vaccinations in a Pediatric Practice

It is very typical for Pediatric practices to begin the process of vaccinating patients with the flu vaccines during September. Although most Pediatric practices maintain a protocol for medical billing related to giving flu vaccinations, it is a good idea to review the common billing practices.
Some questions to ask related to the influenza vaccine include: Will the physicians be examining the high risk patients as part of the flu vaccination process? Will the office set up a flu clinic for which either a Medical Assistant or Nurse administers the vaccine? Will the practice allow flu shots to be administered on weekends or after hours?
Below is the list of CPT as well as vaccination administration codes associated with influenza vaccination.
90655 Influenza virus vaccine, split virus, preservative-free, for children 6–35 months of age, for intramuscular use
90656 Influenza virus vaccine, split virus, preservative-free, when administered to 3 years of age and above, for intramuscular use
90657 Influenza virus vaccine, split virus, 6–35 months of age, for intramuscular use
90658 Influenza virus vaccine, split virus, 3 years and older, for intramuscular use
90660 Influenza virus vaccine, live, for intranasal use

Vaccine Administration Codes also need to be associated with Flu Vaccinations
If the patient is 18 years of age or younger and obtains vaccine counseling by the physician or other qualified health care professional Report CPT code 90460. If both of the criteria are not met (either over 18 years of age or does not obtain vaccine counseling by the provider), utilize the appropriate code from the 90471-90474 series. Utilize CPT Code 90471 if the influenza injection is given as the only vaccine or CPT Code 90473 if the intranasal form is the only provided vaccine. If the influenza vaccine is provided with other vaccines and the patient is either over 18 or the provider does not provide counseling, report 90472 for the influenza injection or 90474 if the intranasal form. Note that the appropriate diagnosis code for the flu vaccine is v04.8

Proper Management of the Front Desk Team & the link to High Collection Rates for Pediatric Practices

August 3, 2012 in Uncategorized by support Team  |  Comments Off on Proper Management of the Front Desk Team & the link to High Collection Rates for Pediatric Practices

The Revenue cycle is comprised of a front, middle and back end. Practice Managers need to optimize all three components for a practice to achieve an optimal collection rate. The front end of the revenue cycle is the front desk team in the practice. The front desk team members of a practice need to verify insurance eligibility as well as collect co-pays and any outstanding balances. Insurance eligibility can be verified via an automated link from the practice management system/clearing house to the insurance companies, Navinet or by calling the insurance companies. The owner as well as the practice manager of a practice need to insure that this activity is occurring accurately and consistently by the front desk team. The practice should check that the co-pay report for the day matches the co-pays collected. Also, the practice owner/manager should check-in with the back end billing team (billing company) to obtain feedback on the rate of accuracy of entering insurance and demographics by the front desk team. “Sloppy” work and/or lack of attention to detail by the front desk team can cause loss of revenue and/or delays in revenue.

The middle of the revenue cycle is comprised of the providers and clinical team properly documenting the charts as well as recording the diagnosis and CPT codes. This should be completed during the day of service and accurately. The back end of the revenue cycle is the billing team ‘scrubbing’ and verifying complete claims prior to sending to the insurance company. Additionally, the back end team will re-submit claims (make appropriate corrections) as well as send out patient statements and communicate to the front desk team for patients that have balances. The front desk team needs to effectively work with the back-end billing team to close the communication gap. When the front, middle and back-end of the revenue cycle is optimized due to good practice management, practices achieve better collection rates and faster payments than the average. For instance, we have practices that are 50% paid by the insurance company five days after the month closes (e.g. July is 50% paid for all insurance charges by August 5th).

Each member of the team needs to understand their role in the revenue cycle. Practice Managers as well as physician partners should be monitoring performance of the front desk team, the providers as well as the work of the back end billing team. Collaboration and cooperation as well as a skilled and dedicated team are critical to achieving the best success.