August 2006 Newsletter

To "Q" You In

By: Quality Assurance Specialist

Administration of Influenza and/or Pneumonia (PPV) Vaccines

CMS Change Request (CR) 5037 provides specific information regarding payment for Influenza and/or PPV vaccines. Effective for dates of service on or after October 1, 2006, the following are the new instructions:

• Report diagnosis code V06.6 on claims when the purpose of the visit was to receive both vaccines.
• Continue reporting diagnosis code V03.08 on claims that contain only PPV vaccine and its administration.
• Continue reporting diagnosis code V04.81 on claims that contain only Influenza vaccine and its administration.
• Use CPT code 90660 on claims when billing for Influenza Virus vaccine, live, for Intranasal use.
• Neither a deductible nor a coinsurance will be applied to CPT code 90660 and its administration.
• Use HCPCS Code G0008 when billing for the administration of CPT code 90660.

Medicare Secondary Payer Claims – Primary Payer is bankrupt

Palmetto GBA recently published an article addressing procedures for billing Medicare Secondary Payer (MSP) claims when the primary payer is bankrupt or insolvent. When a primary payer fails to pay primary benefits because it is bankrupt or insolvent, CMS does not make a conditional primary payment and does not make a Medicare secondary payment until after the conclusion of the bankruptcy or insolvency proceedings. 

After the conclusion of the bankruptcy or insolvency proceedings, providers, physicians, or other suppliers may file Medicare secondary payments. During the liquidation process, participating providers who have accepted assignment may not collect or seek to collect from the beneficiary or the beneficiary’s estate, charges for Medicare covered services. 

The full article can be viewed on the Palmetto GBA Web site.