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#35080 - 09/15/11 02:01 AM Pneumovax reimbursements
fircha Offline

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?

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

Registered: 08/14/04
Posts: 1714
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.
From beautiful southwest Washington State.

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

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.

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

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.
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. "

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

Registered: 08/14/04
Posts: 1714
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.

From beautiful southwest Washington State.

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

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????

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

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

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

Registered: 02/09/11
Posts: 539
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.

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

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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