After many discussions between AHCA/NCAL and the Centers for Medicare and Medicaid Services (CMS) about the confusing payment policies associated with administering preventive vaccines to short- and long term residents in nursing facilities, CMS has issued a concise and helpful
fact sheet that addresses several complex billing scenarios.
The two-page fact sheet explains how Medicare pays for Part B or Part D covered preventive vaccines administered during a patient’s stay in a nursing home. Vaccine payment depends on the type of vaccine and whether the patient is using their Skilled Nursing Facility (SNF) Part A benefit, including scenarios where the resident is also receiving Medicare hospice benefits. This document doesn’t cover vaccine payment by Medicare managed care, Medicaid, or commercial insurance.
The document specifically discusses billing and payment responsibilities associated with the Part D respiratory syncytial virus (RSV) vaccines, and Part B flu, pneumococcal and COVID-19 vaccines. Links to CMS updates to the price and billing codes for the vaccines each year and more information are provided at the end of the document.
AHCA/NCAL recommends that providers share with billing staff, pharmacies, and residents as applicable as it may help clarify who is responsible for submitting the Part B or Part D claims in specific scenarios.