Vaccine administration under Part D

[participant4]

Using the physician web-based portal, how are other plans operationalizing the vaccine administration requirement for Medicare Part D?

[chantell.reagan]

Medicare Part D guidance states that only 3 vaccines are available for coverage through the Part B benefit, including Hepatitis B, Pneumococcal and Influenza vaccines. The rest of vaccines are covered through the Part D benefit. During 2007 calendar year, physicians were allowed to be paid under Medicare Part B for the administration of a Part D-covered vaccine furnished to a Part D beneficiary only if enrolled with the National Supplier Clearinghouse. However, in 2008, the administration of Part D vaccines is covered strictly through the Part D benefit.

In alignment with the CMS guidance for adequate vaccine access, one regional plan is encouraging physicians to send the prescription to local pharmacies that stock vaccines or to use specialty pharmacies in order to ensure proper claims adjudication under the Part D benefit. However at this plan, when a claim for a Part D vaccine is incorrectly submitted through Part B benefit of this regional plan, the claim is correctly resubmitted with a subsequent notification to the physician and patient. This plan is not currently using web-assisted electronic physician billing.

Sources:

Medicare Learning Matters; 2007. Available at: http://www.cms.hhs.gov/MLNMattersArt...ads/MM5486.pdf

Increasing Part D vaccine access. Available at: http://www.cms.hhs.gov/PrescriptionD...s_05.08.06.pdf

Medicare Part B vs. Part D coverage issues. Available at: http://www.cms.hhs.gov/PrescriptionD...c_07.27.05.pdf

Chapter 5 – Vaccines (Sections 60.2-60.2.2, beginning on page 44) http://www.cms.hhs.gov/PrescriptionD...s_03.09.07.pdf

Vaccine Administration: http://www.cms.hhs.gov/PrescriptionD...n_05.14.07.pdf