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Getting Paid for Vaccine Administration

The Centers for Medicare & Medicaid Services more than doubled the reimbursement for COVID vaccines as of March 15, 2021; the payment rate is now approximately $40 per dose. For up-to-date information on payment rates for Medicare, see COVID-19 Vaccines and Monoclonal Antibodies | CMS . If your practice is offering COVID vaccines, you can bill for the shot administration. The process is seamless, but let’s review some tips to ensure that you are getting paid for your hard work:

Submit a single claim per patient – or a roster bill to Medicare for five or more patients. For more information about roster billing for the vaccine, see https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration. For more information about billing for the vaccine for non-Medicare patients, query the payer’s website.

If the vaccine was free to you, charge only the administration.

For Medicare Advantage patients, submit your claims to your Medicare contractor as Original Medicare under Part B coverage using the patient’s Medicare Beneficiary Identifier (MBI). If the patient doesn’t have the MBI, gather the patient’s name, birthdate, and social security number; use this handy guide to query for the MBI. https://www.cms.gov/Medicare/New-Medicare-Card/Providers/MACs-Provider-Portals-by-State.pdf

To get paid for uninsured patients at the Medicare rate; submit the claim for the vaccine administration to: https://www.hrsa.gov/CovidUninsuredClaim.

If you’re having issues with scheduling in your practice management system, download free vaccine scheduling software here: https://www.blockitnow.com/covid.

About The Author

Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.

The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.

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