2011-20122011-2012SEASON SEASON

INFLUENZAINFLUENZA

August 2011 ITV TrainingAugust 2011 ITV TrainingPresented by: Janet OverstreetPresented by: Janet Overstreet

DPH/AFM/LHODPH/AFM/LHOAugust 30, 2011August 30, 2011

For LHDs administering, coding and reporting the influenza vaccine/administration through PSRS/CMS Portal:

--KVP received influenza vaccine --KVP received influenza vaccine (VFC and other KVP provided vaccine) or --Private purchased influenza --Private purchased influenza vaccine vaccine

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Significant CHANGESCHANGES for this year’s reporting:

•Removal of “nominal” fees Removal of “nominal” fees

•Reporting of “vaccine Reporting of “vaccine administration” codesadministration” codes

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Removal of NOMINAL FeesRemoval of NOMINAL FeesDue to Medicaid requirements, nominal fees cannot be charged to some patients and Medicaid be charged at a higher rate.

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

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Collecting & Reporting Patient InformationCollecting & 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.

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Collecting & Reporting Patient InformationCollecting & 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 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

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CANNOT report an Evaluation/Management visit if the patient only receives a flu shot

While 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.

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When reporting the G0008 administration codeG0008 administration code, the 80000 pseudo procedure code will not will not be needed.

When reporting the 9046090460, 9047190471 or 90473 90473 administration codesadministration codes, the 80000 will 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.

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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 administrationadministration should 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

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Questions Questions

Thank YouThank You

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