CMS reversal allows providers to furnish vaccines to patients within hospice election
April 19th, 2014 - Scott KraftProviders are able to bill Medicare for vaccinations given to patients who are under a hospice election, a reversal of a May 2013 transmittal that issued common working file edits designed to ensure that only the hospice would be able to furnish these vaccinations.
CMS details its reversal in transmittal 1339 to its One-Time Notifications Manual. Both institutional and outpatient providers are impacted.
The agency decided that its initial plan to limit billing for vaccine administrations for patients within a hospice election to the hospice was too strict an interpretation of the Medicare Claims Processing Manual, Chapter 18, Section 10.2.4, which states that vaccinations “may be covered when administered by the hospice.”
Because the language within the manual does not say that these vaccinations are coverable only when administered by the hospice, CMS determined that it overreached in its initial interpretation.
In order to be paid for claims for vaccination administration for patients in a hospice election, the provider is to administer modifier GW (service not related to the hospice patient’s terminal condition).
Medicare Administrative Contractors are instructed to be able to pay for hospice vaccinations done by providers as of April 6. Any claims submitted between Oct. 1, 2013 and April 6 that were not paid may be resubmitted.
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