Medicare B Reimbursement for State- Supplied Influenza and Pneumococcal Vaccine Presented by Jennifer Piskorski UMMS

Agenda Project Background Project Collaboration Objective Implementation Vaccine Seasons Results Upkeep Success Future

Background The Department of Health provides state- supplied vaccine free of charge to Massachusetts Boards of Health. Vaccine season , state supplied 195,968 influenza doses to BOH’s. Vaccine season , state supplied 151,443 influenza doses to BOH’s. Vaccine season , state supplied 142,029 flu doses.

Project Collaboration In October 2002, The University of Massachusetts Medical School(UMMS) and the Massachusetts Department of Public Health(DPH) partnered to implement a project that would provide financial benefits to both the State’s Immunization program and Board’s of Health in Massachusetts(BOH’s).

The Objective of the Immunization Project Board’s of Health: –Roster bill Medicare B for administering vaccine to Medicare B beneficiaries. –Volunteer copies of their rosters to UMMS/DPH. –Reimbursed by Medicare B for administering vaccine. UMMS/DPH – Process BOH copies and submits their roster bills to Medicare B. – Reimbursed by Medicare B for vaccine cost. – Revenue returned to the State’s general fund. A financial win-win for both parties.

The Objective: Flow of Information Board’s of Health Submit rosters to Medicare B for Vaccine administration Copies of BOH’s Rosters sent to UMMS/DPH Medicare B Payment UMMS/DPH Submits rosters for vaccine cost to Medicare B

Project Implementation A two step process. –Step one: UMMS and DPH completed and submitted the 855B Medicare B application. The application was accepted and a provider number was issued and received in early Step two:  Inform and educate the Board’s of Health.  Provide the necessary support with educational seminars and contacts.

Outreach to the Board’s of Health To communicate the benefits of this project, DPH sent an informational letter via and fax broadcast, explaining the project’s purpose. The letter addressed all BOH’s categorized as: – Current roster billing – Require roster bill training – Require both a Medicare B provider number and roster bill training.

Results from the first Vaccine Season, A total of 40 BOH’s volunteered copies of their rosters to UMMS/DPH. Those that volunteered, either roster billed previously or were roster billing for the first time. Some cities and towns also submitted previous years( ) to UMMS/DPH. DPH collected a total of $150,000 in Medicare B reimbursement for vaccine cost. This included both and vaccine season.

Medicare B Provider Education From 2002 thru 2003, streams of information and communication between UMMS/DPH, Medicare B, and BOH’s were constant. By September 2003 there was enough interest generated from BOH’s that 7 roster bill training seminars were conducted throughout the State.

Keeping the Project on Track  UMMS/DPH and Medicare B attended BOH’s vaccine clinics to help collect Medicare B beneficiary information and provide hands on support for staff and volunteers working the clinic.  BOH’s were able to contact UMMS/DPH regarding any questions about vaccine doses, roster billing, reimbursement, etc.  Monthly reminders from DPH were ed and faxed to BOH’s requesting copies of their roster bills.

Success Factors Success Factors DPH is anticipating on receiving $300,000 in Medicare B reimbursement for vaccine season BOH’s submitted copies of their roster bills to UMMS/DPH. The rate of denials for incorrect Medicare B beneficiary information has decreased from the previous year.

Board’s of Health Participation A 300% increase since inception

DPH Reimbursement from Medicare B An Expected $350,000 revenue increase

The Future of the State- Supplied Immunization Project There will always be a Frontier where there is an open mind and a willing hand. - Charles F. Kettering

The DPH Incentive Program for BOH’s Any BOH that submits copies of their rosters to UMMS/DPH will receive an additional 10% flu vaccine the following vaccine season. Inquiries from 14 BOH’s within the past month. Expect to generate additional reimbursement for DPH and BOH’s.

Conclusion A revenue enhancement project that benefits both State and local health departments. The effort involved is worth the success of the project. Be a trend setter.