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Ohio Part B Carrier
2009 and 2010 Seasonal Influenza (Flu) Resources for Health Care Professionals

MLN Matters® Number: SE0926 Revised
Related Change Request (CR) #: N/A
Related CR Release Date: N/A
Effective Date: N/A
Related CR Transmittal #: N/A
Implementation Date: N/A
 
Note: This article was revised on October 7, 2009, to include a link on page 3 to MLN Matters® article number MM6608, which includes the payment allowances for the 2009-2010 influenza vaccine. All other information remains the same.
 
Provider Types Affected
All Medicare fee-for-service (FFS) physicians, non-physician practitioners, providers, suppliers, and other health care professionals who bill Medicare for seasonal flu vaccines and vaccine administration provided to Medicare beneficiaries.
 
Provider Action Needed
  • Keep this Special Edition MLN Matters article and refer to it throughout the 2009 - 2010 flu seasons.
  • Take advantage of each office visit as an opportunity to encourage your patients to protect themselves from the seasonal flu and serious complications by getting a seasonal flu shot.
  • Continue to provide the seasonal flu shot as long as you have vaccine available, even after the New Year.
  • Don’t forget to immunize yourself and your staff.  
Introduction
Historically, the flu vaccine has been an under-utilized benefit by Medicare beneficiaries. Yet, of the nearly 36,000 people who, on average, die every year in the United States from seasonal flu and complications arising from the flu, the majority of deaths occur in persons 65 years of age and older. People with chronic medical conditions such as diabetes and heart disease are considered to be at high risk for serious complications from the flu, as are people in nursing homes and other long-term care facilities. Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.
 
The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare Part B reimburses health care providers for seasonal flu vaccines and their administration. (Medicare provides coverage of the seasonal flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) All adults 65 and older should get seasonal flu and pneumococcal immunizations. People with Medicare who are under 65 but have chronic illness, including heart disease, lung disease, diabetes or end-stage renal disease should get a seasonal flu shot.
 
Prevention is Key to Public Health!
While flu season can begin as early as October and last as late as May the optimal time to get a flu vaccine is in October or November. However, this year, due to planning for H1N1 flu, Medicare will make payment for seasonal flu vaccines that are provided earlier in the year than usual. Seasonal flu vaccines can still help protect Medicare beneficiaries who get the vaccine in December or later. The flu vaccine continues to be the most effective method for preventing flu virus infection and its potentially severe complications.
 
You can help your Medicare patients reduce their risk for contracting seasonal flu and serious complications by using every office visit as an opportunity to recommend they take advantage of the annual seasonal flu shot benefit covered by Medicare. And don’t forget, health care providers and their staff can spread the highly contagious flu virus to their patients. Don’t forget to immunize yourself and your staff.
 
The following educational products have been developed by CMS to be used by Medicare FFS health care professionals and are not intended for distribution to Medicare beneficiaries.
 
Educational Products for Health Care Professionals
CMS has developed a variety of educational resources to help Medicare FFS health care professionals understanding coverage, coding, billing, and reimbursement guidelines for seasonal flu vaccines and their administration.
 
1. MLN Matters Seasonal Influenza Articles
2. MLN Seasonal Influenza Related Products for Health Care Professionals
  • Quick Reference Information: Medicare Part B Immunization Billing - This two-sided laminated chart provides Medicare FFS physicians, providers, suppliers, and other health care professionals with quick information to assist with filing claims for the seasonal influenza, pneumococcal, and hepatitis B vaccines and their administration. This product is available in print and as a downloadable PDF at http://www.cms.gov/MLNProducts/downloads/qr_immun_bill.pdf on the CMS website. 
  • The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals, Third Edition - This updated comprehensive guide to Medicare-covered preventive services and screenings provides Medicare FFS physicians, providers, suppliers, and other health care professionals information on coverage, coding, billing, and reimbursement guidelines of preventive services and screenings covered by Medicare. The guide includes a chapter on seasonal influenza, pneumococcal, and hepatitis B vaccines and their administration. Also includes suggestions for planning a flu clinic and information for mass immunizers and roster billers. The guide is available as a downloadable PDF file at http://www.cms.gov/MLNProducts/downloads/mps_guide_web-061305.pdf on the CMS website. 
  • Medicare Preventive Services Adult Immunizations Brochure - This two-sided tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of influenza, pneumococcal, and hepatitis B vaccines and their administration. This brochure is available as a downloadable PDF file at http://www.cms.gov/MLNProducts/downloads/Adult_Immunization.pdf on the CMS website. 
  • Quick Reference Information: Medicare Preventive Services - This two-sided laminated chart gives Medicare FFS physicians, providers, suppliers, and other health care professionals a quick reference to Medicare’s preventive services and screenings, identifying coding requirements, eligibility, frequency parameters, and copayment/coinsurance and deductible information for each benefit. This chart includes seasonal influenza, pneumococcal, and hepatitis B vaccines. This chart is available in print or as a downloadable PDF file at http://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf on the CMS website. 
  • Medicare Preventive Services Bookmark - This bookmark lists the preventive services and screenings covered by Medicare (including seasonal influenza) and serves as a handy reminder for health care professionals of the many preventive benefits covered by Medicare. Appropriate for use as a give away at conferences and other provider related gatherings. This bookmark is available in print or as a downloadable PDF file at http://www.cms.gov/MLNProducts/downloads/medprevsrvcesbkmrk.pdf on the CMS website. 
  • MLN Preventive Services Educational Products Web Page - This Medicare Learning Network (MLN) web page provides descriptions of all MLN preventive services related educational products and resources designed specifically for use by Medicare FFS health care professionals. PDF files provide product ordering information and links to all downloadable products, including those related to the seasonal influenza vaccine and its administration. This web page is updated as new product information becomes available. Bookmark this page (http://www.cms.gov/MLNProducts/35_PreventiveServices.asp) for easy access.
3. Other CMS Resources
4. Other Resources
The following non-CMS resources are just a few of the many available in which clinicians may find useful information and tools to help increase seasonal flu vaccine awareness and utilization during the 2009 – 2010 flu season:
Other sites with helpful information include:
Beneficiary Information
For information to share with your Medicare patients, please visit http://www.medicare.gov on the Internet.
 
Important information about H1N1:
Medicare will cover immunizations for H1N1 influenza, also called the "swine flu." There will be no coinsurance or copayment applied to this benefit, and beneficiaries will not have to meet their deductible. H1N1 influenza vaccine is currently under production and will be available in the fall of 2009. For more information, go to http://www.cms.gov/H1N1 on the CMS website.
 
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

 

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last updated on 10/13/2009
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