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FQHC Vaccine Billing

  1. Question FQHC Vaccine Billing
    Medical Coding Books
    Good Afternoon Subject Matter Experts,

    I currently work for an FQHC (Federally Qualified Health Center) can someone point me in the direction of the regulations regarding Billing for Adult Immunixzation Vaccines??

    As I have been told the requirements for an FQHC are different than other Outpatient facilities and the claim needs to be submitted with a copy of the Vaccine Invoice for the Adult patient populations.

  2. #2
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    Lynchburg, Virginia
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    Quote Originally Posted by Rperry View Post
    Good Afternoon Subject Matter Experts,

    I currently work for an FQHC (Federally Qualified Health Center) can someone point me in the direction of the regulations regarding Billing for Adult Immunixzation Vaccines??

    As I have been told the requirements for an FQHC are different than other Outpatient facilities and the claim needs to be submitted with a copy of the Vaccine Invoice for the Adult patient populations.
    I have billed for an RHC for four years and just moved to billing for a FQHC, which are the same when billing for immunizations (as far as I can tell from research). So, when you bill commercial insurances for adult immunizations, you just bill them as you normally would. When you bill Medicare, flu and pneumonia are taken care of on the cost report, no line items are billed. Hep B is covered for patients who are at high risk for contracting the disease, but payment is included in the encounter rate. I usually bill out all other vaccinations as line items with the expectation that they won't be covered. They are on the claim for coding and cost report purposes.

    The only insurance I have ever known to ask for any specific information regarding vaccines is Tricare. (I am in Tricare North region) You have to submit lot numbers, etc. with vaccinations to Tricare.

    Hope this helps!
    Janice B, CPC

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