CMS: Effective October 1, 2013 Non-Hospice Claims for Hospice Patient Vaccines will be Rejected
May 15, 2013 04:27 PM
In a Change Request (CR 8098) issued May 3, 2013, the Centers for Medicare & Medicaid Services (CMS) indicated that, effective October 1, 2013 - and for implementation on October 7, 2013 - Medicare systems will prevent non-hospice providers from providing vaccines to hospice beneficiaries. While a hospice may provide influenza, pneumococcal, and hepatitis B vaccines to beneficiaries who request them and - in such cases these services are only covered by Medicare when provided to hospice beneficiaries by their hospice provider - Medicare systems previously did not have the ability to differentiate between claims for the vaccines submitted by hospices and other providers/suppliers.
CMS has now established an edit to the Common Working File (CWF) that allows the Medicare Administrative Contractors (MACs) to reject claims submitted by non-hospice providers for vaccines provided to hospice beneficiaries.
CMS has created a useful document related to immunizations, titled2012- 2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP Coverage of Seasonal Influenza and Pneumococcal Vaccinations Steps to Promoting Wellness Immunizations for reference by providers.
Additionally, the Medicare Claims Processing Manual, Chapter 18 - Preventive and Screening Services, provides the following guidance:
10.2.4 - Bills Submitted by Hospices and Payment Procedures for Renal Dialysis Facilities (RDF)
(Rev. 1586, Issued: 09-05-08, Effective: 10-06-08, Implementation: 10-06-08)
Hospices can provide the influenza virus, pneumococcal, and hepatitis B vaccines to those beneficiaries who request them including those who have elected the hospice benefit. These services may be covered when furnished by the hospice. Services for the vaccines should be billed to the local carrier/AB MAC on the Form CMS-1500. Payment is made using the same methodology as if they were a supplier. Hospices that do not have a supplier number should contact their local carrier/AB MAC to obtain one in order to bill for these benefits.