Zostavax

[nc_coder]

We are a Family Practice that administers the Zostavax vaccine for shingles. Medicare does not pay for this when done in our office, but if the patient were to go to a pharmacy and have the pharmacist administer the vaccine, their Part D would pay. The patients are left with a bill for over $200 when it is done in our office. We are not educating the patients at all on this and not even warning the patients up front that Medicare does not pay. The only time they are told is if they specifically ask if it is covered. I have asked our office manager before if we should be telling the patients upfront or have them sign a waiver. She says we don't have to if it is a charge that is routinely denied by Medicare and it is the patient's responsibility to know what is covered. I'm not sure I completely agree. I just wanted to see what others thought about this situation.

[ajs]

Originally Posted by nc_coder

We are a Family Practice that administers the Zostavax vaccine for shingles. Medicare does not pay for this when done in our office, but if the patient were to go to a pharmacy and have the pharmacist administer the vaccine, their Part D would pay. The patients are left with a bill for over $200 when it is done in our office. We are not educating the patients at all on this and not even warning the patients up front that Medicare does not pay. The only time they are told is if they specifically ask if it is covered. I have asked our office manager before if we should be telling the patients upfront or have them sign a waiver. She says we don't have to if it is a charge that is routinely denied by Medicare and it is the patient's responsibility to know what is covered. I'm not sure I completely agree. I just wanted to see what others thought about this situation.

Here is a link for some guidance from Medicare through a MedLearn article:

https://www.cms.gov/MLNMattersArticl...ads/SE0678.pdf

Patients should be informed of the cost and told they can bill their Part D insurance for some reimbursement of the cost. An ABN is not required, but it is generally a good practice for providers to let their patients know when a service is not likely to be covered by their insurance.

[DGRAF]

You could as a courtesy lest your patients know that they can submitt the charges to their Part D and get reimbursed. I work in Internal medicine and we too charge patients for the injection, they however are aware at the time of the service as they need to pay upfront. Most Part D will pay with a receipt and definition of the service provided.