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Flu Shots / Co pays

  1. #1
    Location
    Gulf To Bay, Clwtr FL
    Posts
    19
    Default Flu Shots / Co pays
    Medical Coding Books
    HI all!

    This is more of a general billing question that has been up for debate for sometime in our office. Wanted to see how other practices are handling the situation...

    1st we are Pediatrics....

    So the debate every year is if we should collect co pays up front when a child comes in for a flu shot only(our office checks in the pateint @ beginning of visit) . From the coding stand point, if we are billing the Flu shot only w/admin we should not collect co pays (there are very few plans that require a co pay with vaccines). The doctors debate is that most of the time the parent will ask questions concerning other issues, that would then prompt an office visit to be billed, then a copay would need to be collected. They state it is eaiser to collect up front, than to send the patient back out to collect @ the end. From a billing stand point this makes alot of credits for us for the rest of the year, which is not fun to deal with. In an ideal situation the member would know their benefits, but they never do. Also we are a very busy practice (100-115 pt a day, alot of same day appts) so it is almost impossible to verify pt benefits before the visit....

    So how does your office handle these visits? Any feed back would be great! Also, does your doctor even go into the room for these visits, or do only the nurses handle these visits?

    Thank you!

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    you could not collect a copay up front for a planned flu shot or requested flu shot. You may not charge a 99211 for this and charge the admin fee plus vaccine code. If the patient brings up other issues which requires physician involvement, then at that point yopu can expalin to the patient taht a physician encounter is necessary and a copay will be required. Or you can reschedule for the another day. The nurse may not address new issues with the patient and charge an office encounter. Any issues regarding the flu shot is part of the administration charge. If the physician comes into the room then he must document an encounter for an issue unrelated to the flu shot. Because just like the physician cannot charge an E&M when the patient comes in for a scheduled procedure they cannot charge an E&M for a scheduled flu shot. A 99211 is truely not a nurse visit, it is a physician level, but it is the level the physician is allowed to charge when ancillary persons are in the room with the patient (while the physician is elsewhere in the office) to carry out orders from the physician in a previous encounter and no other code is available to use.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    We don't collect a copay for flu shots and if the patient does end up being seen for something, then we send them to our check-out window and that person is informed that the patient was seen and they collect if necessary.

  4. #4
    Default
    We do not charge a co-pay either. If there insurance applies flu shots to the copay/ded/coins we will just bill the patient. It makes to big of a mess with credits on the accounts.

  5. #5
    Location
    Gulf To Bay, Clwtr FL
    Posts
    19
    Default
    Thanks so far for the feedback...just want to clairfy.....We do not charge a 99211 and and admin fee. The situations I am refering to is: mom brings in child for a scheduled flu shot...once in the room she tells the nurse " well you know her ear has been hurting her" or something along that line...which would in turn promt the Dr to exam the child, perscribe meds if need...so a 992XX would be billed, level depending on how complicated the issue is.......does that make sense? Should we be telling these familys to come back for another visit?

    thanks again!

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by JodiLynn View Post
    Thanks so far for the feedback...just want to clairfy.....We do not charge a 99211 and and admin fee. The situations I am refering to is: mom brings in child for a scheduled flu shot...once in the room she tells the nurse " well you know her ear has been hurting her" or something along that line...which would in turn promt the Dr to exam the child, perscribe meds if need...so a 992XX would be billed, level depending on how complicated the issue is.......does that make sense? Should we be telling these familys to come back for another visit?

    thanks again!
    The patient should be told that the physician can see them for this problem but there will need to be a copay for the encounter. I know it seems really harsh but patients need to be trained if you will that physician services are valuable and need to be paid for.

    Debra A. Mitchell, MSPH, CPC-H

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