Healthcare Provider Solutions

 

This Monday Minute with Melinda video clip reviews the details of the Condition Code that must be used in billing vaccine administration for Medicare Advantage enrolled patients. Additionally, we touch on the extension of the PHE and corresponding CMS Waivers.

Hello, everyone, and welcome to our Monday Minute. There’s a couple of things that I would like to review with you today. First of all, I’m sure most of you are aware that the Public Health Emergency has been extended. It was set to originally expire on April 23. It can only be renewed 90 days at a time, and it was renewed and will currently be going through at least the third week of July. In addition to that, or in the same light, make sure that you remember and take into consideration that the COVID-19 waivers that were put in place to coincide with the Public Health Emergency will continue until the end of the Public Health Emergency. Also making sure that you are preparing, as we do hope and pray that the Public Health Emergency will end officially, at some point. At that end, those waivers will no longer be in effect. So, you need to make preparation, or begin making preparation for those waivers to end and when they do that your agency is fully prepared to go back to regulatory requirements outside of the waivers.

In addition to that, I want to provide some clarification today on one of our recent Monday Minutes. Recently, we discussed the billing of COVID vaccine administration, specifically by home health and hospices and the reality that you can be paid $40 per injection for both the first and second injection for the Pfizer and Moderna vaccines. With that billing, you are to bill traditional Medicare even if the patient is a Medicare Advantage patient. There has been some hoopla about that because agencies were receiving rejected claims, if it were a Medicare Advantage patient. Even when contacting the provider contact center, they are given the instruction that Medicare was not going to pay for Medicare Advantage plans vaccine injections. That is not true. On April 21 Palmetto GBA did posts and detail instructions, including that your claim being submitted to Medicare for payment for COVID vaccine administration to a Medicare Advantage patient must include the condition code 78. With that 78-condition code your claim should pay by Original Medicare even though it is a Medicare Advantage patient. The detail of this Monday Minute will include a link to the detail that was posted on April 21 to include all the specifics of information that you need to include so that those COVID vaccine administration payments are made to you as they should be.

Thank you all for being on the front line and taking care of patients during this critical time in our history. And thank you all for participating in healthcare, period. We are here to help if there is anything that we can do for you. And please make sure you stay tuned in with and support your state and national homecare and hospice associations. Have a great day!

If you need additional information feel free to give us a call orĀ contact us. HPS is always here to support you.

Resources:

https://www.palmettogba.com/palmetto/jmhhh.nsf/DIDC/UZH9MAVTII~Emergency%20and%20Disaster%20Instructions

If you enjoyed today’s content be sure to check out the HPS Alliance where members receive exclusive content, webinars, and ongoing updates from our industry-leading educators.