8 ways to make adult vaccinations profitable
2 Consider a vaccine purchasing group
Buying vaccines through a purchasing group, which takes many independent practices together and negotiates the lowest possible fee for bulk purchases, is the most cost-effective way to buy vaccines. A practice that doesn’t belong to a vaccine purchasing group is missing an opportunity to save money, say experts.
Purchasing directly from manufacturers is the next-best option for obtaining a good price. The most expensive method is to buy vaccines through a third-party reseller or vendor. Its costs and associated fees are going to be higher than going through the manufacturers directly. Goldman advises avoiding these vendors or resellers who sell the vaccine at a marked-up price.
Goldman always looks for the most economical way to purchase vaccines. “If I pay promptly I get another discount, and if I buy multiple vaccines, I get another discount,” he says.
3 Manage billing
New ICD-10 codes make billing for vaccines easier.
“If you don’t know the codes, you’re not going to get the reimbursement,” says Goldman. Only one diagnosis code—Z23—accounts for immunizations, whereas previously each vaccine needed its own diagnosis code. Each type of vaccine then has an administration code—whether pneumonia, flu, tetanus or hepatitis.
Federal law mandates that insurance companies reimburse for the cost of all vaccines recommended from the American College of Immunology and the Advisory Committee for Immunization Practices. These groups, along with the CDC, determine the recommendations for patients under 65. But administration of the immunizations is left to payer negotiations for reimbursement.
Goldman explains that Medicare has specific billing guidelines: The pneumonia, hepatitis B and flu vaccines all are reimbursable under part B. As long as physicians follow the guidelines, they will receive reimbursement.
Other vaccines, including those for shingles, hepatitis A and tetanus, fall under Medicare part D. Many physicians mistakenly refer patients to a pharmacy for these vaccinations because they didn’t realize they were reimbursable. There is computer software available that will allow a physician’s office to submit claims under a pharmacy billing code to receive reimbursement for these vaccines. That software, TransactRx, is available for free, will also check if the patient is not covered or if their coverage doesn’t include vaccines.
Software is available from Merck that will check vaccination coverage for Medicare patients and allow physicians to receive reimbursement for vaccinating those patients.
4 Defer payment
Most vaccine manufacturers, along with vaccine purchasing groups, have a 60-day payment term, at the end of which a practice could pay, and do so with a credit card. Since credit card statements come back 30 days later, a practice could wait nearly 90 days before having to pay for its vaccines.
Even better, some manufacturers and most vaccine purchasing groups offer a deferred invoice so practices don’t have to pay for three months. “So you get the vaccine, you administer it, you get the reimbursement and they don’t bill your credit card for three months,” says Goldman.
5 Get a handle on reimbursement
While physicians often experienced long delays and inadequate reimbursements in the past, these should not be problems today.
Typically, it takes about seven to 10 days to get reimbursed for vaccines if physicians are using an electronic system and submit clean claims. Practices that are having problems with reimbursement are either not using their billing software correctly or filing claims incorrectly. The most common billing problems include entering incorrect information, inputting the wrong codes and mismatching treatment and diagnosis codes.