As COVID-19 vaccinations continue to be administered nationwide from providers hence every provider is looking for an answer of “can providers seek reimbursement from patients for the vaccination through balance billing”? To get more clarity, you need to know balance billing as well as the COVID-19 vaccinations program and its compliance in detail.
What is Balance Billing?
Balance billing is the difference between the provider’s charge and the allowed amount. For example, if the charge of the provider is $120 and the allowed amount is $70, then balance billing is remaining $50. A preferred provider may not balance bills to patients for covered services.
Currently, COVID-19 Vaccination Program is carried out in the US where the US government purchased all COVID vaccines and its administration is exclusively done by providers enrolled in the COVID-19 Vaccination Program.
However, OIG stated that vaccine providers cannot charge or seek reimbursement from patients for the vaccines but these providers or healthcare organizations can bill third-party payers for an administration fee.
When we talk about an administration fee, it completely depends on the payer’s applicable medical billing rules. The payers include Medicare, Medicaid, and private payers and the Health Resources and Services Administration’s (HRSA’s) COVID-19 Uninsured Program.
The program exclusively demands that all participating organizations and providers must administer the vaccines with no out-of-pocket cost to recipients. These costs are fees for office visits or other charges in the case of only COVID-19 vaccination provided.
Moreover, the COVID-19 Vaccination Program stipulates that providers may not seek any reimbursement from patients for the vaccination through balance billing. However, it is observed some patients filed complaints about charges by providers when getting their COVID-19 vaccines.
To resolve these complaints government watchdog explicitly wrote a message to OIG and now providers that charge impermissible fees need to refund patients in the future and ensure that no fees should be charged from an individual in case of COVID-19 vaccine or vaccine administration in the future.
Now, you understand about the COVID-19 vaccinations program but one thing that should note here is Provider compliance is very important for the successful implementation of the program.
Now you are clear with compliance still if you are a Medicare-enrolled provider then you can bill Medicare for administering COVID-19 vaccines to Medicare patients. Let’s understand how to do that-
How to Bill for COVID-19 Shot Administration?
- You can bill on single claims for COVID-19 shot administration, or submit claims on a roster bill for multiple patients at one time.
- Only bill for the vaccine administration and don’t include the vaccine codes on the claim when the vaccines are free.
- You can’t charge your patients or ask them to submit a claim to Medicare or another insurer.
- You can still submit a claim to Medicare for administering the vaccine though you get government funding to help pay for administering the COVID-19 vaccine.
Finally, for the uninsured patient, Providers can submit claims to the HRSA’s COVID-19 Uninsured Program for administering doses to uninsured patients and reimbursement will be done at the Medicare rate. We are always keeping an eye on the latest updates in healthcare and helps providers to get their claims reimbursed timely efficiently. If you are struggling with medical billing and coding, you can get in touch with us.
Are You Ready to Get Billing?
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