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Billing workflow, optimizing with ver 9?
by jrav
03/23/17 07:48 PM
Help! Any quick way to re-print scripts if rx screen has closed???
by Bert
03/22/17 11:31 PM
report for patients without telephone number
by JamesNT
03/22/17 06:16 PM
New Pharmacies
by JohnG
03/21/17 07:25 PM
How do I design a report to List "Active Patients"
by Bert
03/21/17 04:46 PM
importing items to hosted AC
by Aldo
03/21/17 01:00 AM
add med list button in sign off screen
by Bert
03/20/17 09:56 PM
Can AC send Lab orders electronically to Quest Labs?
by Marty_PA
03/17/17 05:48 PM
Appointment reminders - AC? Updox?
by Steven
03/17/17 02:30 AM
Is there a way to make AC NOT save 2 pharmacies?
by Dr_AJ
03/16/17 09:43 PM
If you read nothing else about MIPS/MACRA please read this
by JBS
03/15/17 03:09 PM
How to export names and addresses of active patients
by Bert
03/13/17 02:57 AM
AC Training For A New Provider
by Bert
03/13/17 02:39 AM
How to change orders in orders box
by Dr_AJ
03/10/17 07:36 PM
MACRA/MIPs for 2017 - Avoid any reduction in 2019 Reimbursements
by JBS
03/07/17 12:47 AM
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#35080 - 09/15/11 02:01 AM Pneumovax reimbursements
fircha Offline
Member

Registered: 01/09/10
Posts: 23
Loc: NC
We have reached a point in our office where we can no longer afford to give Pneumovax with the price hikes, as the current cost is not being completely covered under the insurance reimbursements. Of course, we cannot charge the patient the difference.

Does anyone have this same kind of problem? If so, how are you handling it?

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#35081 - 09/15/11 02:03 AM Re: Pneumovax reimbursements [Re: fircha]
Steven Offline
Member

Registered: 08/14/04
Posts: 1715
Loc: South Bend, WA
Find a local pharmacy who wants business and refer all to them - have not done in years as it is not worth hassle and they love to do them.
_________________________
Steven
From beautiful southwest Washington State.
www.facebook.com/WillapaFamilyMedicine

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#35106 - 09/15/11 07:52 AM Re: Pneumovax reimbursements [Re: fircha]
IntMedDoc Offline
Member

Registered: 10/16/08
Posts: 18
Loc: IL
How did you determine that it is not worth administering the vaccinations? From what I read in Illinois, (WPS Medicare) you still come out on top when billing for the vaccination and administration.

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#35110 - 09/15/11 01:03 PM Re: Pneumovax reimbursements [Re: fircha]
Leslie Offline
Member

Registered: 02/15/05
Posts: 2002
Loc: Central Oregon
I gave up all vaccines many years ago as it was too much of a hassle and the cost was more than the reimbursement. I have only recently started giving tetanus again. Everything else goes to the pharmacies.
_________________________
Leslie
Hospital Employed Physician Who Misses The Old AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "

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#35112 - 09/15/11 01:19 PM Re: Pneumovax reimbursements [Re: fircha]
Steven Offline
Member

Registered: 08/14/04
Posts: 1715
Loc: South Bend, WA
You may make a little on a vaccination - assuming you never get one denied, they never decide that since you did on the day of a visit that they will bundle the admin charge and only pay you for the visit or the admin fee (have not had with pneumovax, but have had insurance companies decide to pay me 28 dollars for EKG and disallow the Level 4 office visit). The problem is that we can spend a lot of time trying to see if we can make a few dollars doing something or just concentrate on visits and medical management. I have seen tetanus shots denied left and right by Medicare even when given for an open wound so I just figured that if you make 10 bucks on one, but get one disallowed out of 10 then you are not ahead.

_________________________
Steven
From beautiful southwest Washington State.
www.facebook.com/WillapaFamilyMedicine

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#35113 - 09/15/11 02:23 PM Re: Pneumovax reimbursements [Re: fircha]
StLawrence Offline
Member

Registered: 06/07/09
Posts: 487
Loc: New York
We just looked at this. Clearly, the cost of pneumovax now exceeds medicare reimbursement. That is excluding the syringe and someone to give it. We pay more for the vaccine than medicare pays us. And there is curiosity out there as to why we don't vaccinate????

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#35126 - 09/15/11 05:51 PM Re: Pneumovax reimbursements [Re: fircha]
chazli Offline
Member

Registered: 04/26/06
Posts: 124
Loc: NC
That is EXACTLY the situation that we have in the office. Are we doing something wrong? How is it a pharmacy can get paid for it, but the MD cannot? I do not see that the pharmacies will eat up these costs, as it is not just breaking even.
Any thoughts?
_________________________
Mercy Medical Clinic
OM for Solo IM

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#35131 - 09/15/11 06:29 PM Re: Pneumovax reimbursements [Re: fircha]
DCubed Offline
Member

Registered: 02/09/11
Posts: 540
Loc: Baltimore
I just bought a vial of Pneumovax 23.
Here are the stats:

Cost/dose: 53.16
Medicare listed payment for our geographic area:
Vaccine 90732: 57.19
Administration G0009: 24.69

Have you all looked at your current numbers?

Some years ago, my supply company was charging way too much, and yes, the cost exceeded the reimbursement, so I changed suppliers.
_________________________
Donna

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#35132 - 09/15/11 06:49 PM Re: Pneumovax reimbursements [Re: fircha]
StLawrence Offline
Member

Registered: 06/07/09
Posts: 487
Loc: New York
I imagine that this has alot to do with differences in regional reimbursement rates. Although it is a federal program, reimbursements vary by region/carrier and so does the coverage of different codes. One discovers this when they relocate.

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