2012-20132012-2013SEASON SEASON

INFLUENZAINFLUENZA

ITV TrainingITV TrainingPresented by: Janet OverstreetPresented by: Janet Overstreet

DPH/AFM/LHODPH/AFM/LHOAugust 20 , 2012 2:00-3:30pmAugust 20 , 2012 2:00-3:30pm

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Training for LHDs: who will be providing seasonal influenza vaccinations and reporting them through the Patient Encounter Reporting System:

--VFC received influenza vaccine, --VFC received influenza vaccine, or --Private purchased influenza vaccine--Private purchased influenza vaccine

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The Influenza Administration Record has the Vaccine Information Sheet (VIS) updates.

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Collecting & Reporting Patient InformationCollecting & Reporting Patient Information•REMINDER that it would be important to collect income information if:

•Self-Pay VFC eligible patients and charging the administration on the Sliding Fee•Other than VFC patients, if you provide flu vaccine and administration to patients and charging on a Sliding Fee

•If the patient does not complete the Household and Income fields, you may :

• enter 1 - for “number in household” • leave “annual income” field blank and enter “income assessed date” as the date of service (it will show on label as “N/A”); Income should default in the system at encounter entry to 100% pay

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Collecting & Reporting Patient InformationCollecting & Reporting Patient InformationFixed-Full Charge (FFC):

•May be used for self-pay patients for which your agency has purchased private stock vaccines and will be administering to the patient

•When flagged, the FFC rate will be assessed to the patient regardless of the amount of income listed for the patient

•Providing the influenza vaccination at a Fixed-Full Charge to the self-pay patient; the service is charged at the FFC rate set in the 501 Service File unless otherwise authorized by DPH.

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continued…

•FFC FFC may be used for reporting Self-Pay VFC eligible patients, however, they cannot be charged more than $14.17 for the administration; DPH has approved an over-ride rate rounded to $14.00

•*“VFC-enrolled providers may not charge a vaccine administration fee to VFC-entitled children that exceed the regional administration fee cap per dose of vaccine.“

•*“For established VFC-eligible patients and other VFC-eligible patients that the provider chooses to immunize, VFC immunization cannot be denied due to the inability to pay an administration fee.” (Section 1928 (c)(2)(C)(iii) of the Social Security Act)

*Source: http://www.cdc.gov/vaccines/programs/vfc/projects/faqs-doc.htm

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Assessing IncomeAssessing Income

• If the patient has had income assessed in the past six (6) months, there is no requirement to re-assess the income.

• You will need to assure that if you change the income in the system, it does not pose issues for established patients who are participating in other LHD programs.

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IF THE PATIENT ONLYONLY RECEIVES A FLU SHOT, an EEvaluation/MManagement visit CANNOTCANNOT be reported.

While receiving a flu shot, if the patient receives an an additional service requiring an E/Madditional service requiring an E/M reported for different diagnosis code; the problem-focused E/M code will need to be reported with a 25 modifier.

Example:Example: patient presenting for family planning patient presenting for family planning birth control supplies and gets a flu shot birth control supplies and gets a flu shot

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Bottom half of the Seasonal Influenza Vaccine Administration Form.

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Rev. rates 8/1/12

(New)

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When reporting the G0008 administration codeG0008 administration code, the 80000 pseudo procedure code will not will not be needed. be needed.

When reporting the 9046090460, 9047190471 or 90473 administration 90473 administration codescodes, the 80000 will will be needed.

If billing Medicare or insurances, use the administration codes required by those third parties.

When coding by component When coding by component you should review the VIS form thoroughly with the patient/parent/legal representative, discuss the risk, benefits and side effects and document that you counseled per component.

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If your LHD wants to request different rates for FLU vaccine administrationadministration than those in the system:

• Send your request to the Local Health Help Desk at LocalHealth.HelpDesk@ky.gov

• RequesRequest for Influenza administrationadministration for self-pay patients should be no less than $18.00 if your agency is billing Medicaid (REMINDERREMINDER: VFC eligible patients cannot be charge more than $14.17 per immunization)

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INFLUENZA VACCINE private stock:INFLUENZA VACCINE private stock:

DPH will have listed in the 501 Service File the highest rate per CDC private sector dose;

LHDs may choose to over-ride Private dose Influenza VaccineInfluenza Vaccine with a lesser ratelesser rate without written approval from DPH (example on following slide #15).

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RATE(administration) 90471 or G0008 $22.00 (FFC rate in Service File)(vaccine) 90658NV 3.00 (over-ride)

Example for $25.00 (reporting as FFC):

25.00

NV

NV

PEF

ENTRY

BILL

SCREEN

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Example for reporting as Slide): RATE

(administration) 90471 or G0008 $18.00 (Slide 100% rate in Service File)(vaccine) 90658NV 12.00 (Slide 100% rate in Service File)

PEF

ENTRY

BILL

SCREEN

%PAY

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Questions Questions

Thank YouThank You

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