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2011-2012 SEASON INFLUENZA. August 2011 ITV Training Presented by: Janet Overstreet DPH/AFM/LHO August 30, 2011.

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2011 2012 season influenza

2011-2012SEASON INFLUENZA

August 2011 ITV Training

Presented by: Janet Overstreet

DPH/AFM/LHO

August 30, 2011

slide2

For LHDs administering, coding and reporting the influenza vaccine/administration through PSRS/CMS Portal: --KVP received influenza vaccine (VFC and other KVP provided vaccine)or--Private purchased influenza vaccine

significant changes for this year s reporting

Significant CHANGESfor this year’s reporting:

Removal of “nominal” fees

Reporting of “vaccine administration” codes

removal of nominal fees

Removal of NOMINAL Fees

Due to Medicaid requirements, nominal fees cannot be charged to some patients and Medicaid be charged at a higher rate.

How does this affect what information we collect from the patient and report in the system?

collecting reporting patient information

Collecting & Reporting Patient Information

There has been added fields to collect:

Number in Household

Income or Income NOT Given

This will be important for:

Self-Pay KVP/VFC eligible patients (if not reporting as Fixed-Full Charge)

Other than KVP, if you provide flu shots to patients on a Sliding Fee

If the patient does not complete these fields, you may

use: 1 - for number in household

99999 - for income or income not given

If your agency chooses not to take income, blank out the Income fields on the

Vaccine Administration form and use 99999 as Income for patients you will

not be doing as a Fixed-Full Charge. You will need to assure this does not pose

issues for established patients who are participating in other LHD programs.

collecting reporting patient information7

Collecting & Reporting Patient Information

Fixed-Full Charge

May be used for patients for which your agency purchased private stock vaccine and does not have a third party payor being billed

Income will not effect the charge; with the exception of Insurance co-pays (we are working with CDP to try and get that corrected)

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

slide8

CANNOT report an Evaluation/Management visit if the patient only receives a flu shotWhile receiving a flu shot, if the patient receives and additional service requiring an E/M reported for different diagnosis code; the E/M will need to be reported with a 25 modifier.

slide12

When reporting the G0008 administration code, the 80000 pseudo procedure code will not be needed.When reporting the 90460, 90471 or 90473 administration codes, the 80000 will be needed.When coding by component you will need to review the VIS form thoroughly with the patient/parent/legal guardian, discuss the risk, benefits and side effects and document that you counseled per component.

if your lhd wants to request different rates than those in the system

If your LHD wants to request different rates than those in the system:

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

Request for Influenza administrationshould be no less than $18.00 if your agency is billing Medicaid (except for KVP eligible patients cannot be charge more than $14.17 per immunization)

LHDs may request Private dose Influenza Vaccine at a lesser rate than the recommended DPH rate