Vaccine Reimbursement Guidelines For Home Health Agencies

Posted on Wednesday, September 23, 2015 4:09 PM

For the 2015-2016 influenza season, many home health agencies have questions regarding reimbursement rates for providing the flu vaccine to patients and the community. When providing vaccines, there are two payment rates agencies must consider: payment for the vaccine itself and the payment to administer it. Home health agencies are reimbursed for the vaccine on a reasonable cost basis; Medicare recognizes the reasonable, allowable cost for the vaccine. However, if an agency’s intermediary believes that the agency has unreasonably incurred cost for the vaccine, or has not been a prudent buyer, it is up to the agency to support that it was prudent and that the costs are reasonable. If the agency cannot, the intermediary will not recognize the unreasonable portion of the incurred cost. Reimbursement for the vaccine administration is based on the outpatient prospective payment system (OPPS) vaccine administration rate, which is determined each calendar year (CY). Sixty percent of the rate is adjusted using the hospital wage index for the core based statistical area (CBSA) where the service is provided. The 2015 OPPS rate for the influenza vaccine administration is $32.57. Click here to for the Medlearn Matters “QUICK REFERENCE INFORMATION: Medicare Immunization Billing” for influenza vaccine and vaccine administration billing codes.   Click here for more information from NAHC.

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