Online Tutorial for Vaccine Providers: Accurate Claims Coding
July 16, 2009
1:00 pm – 2:30 pm ETWhen immunization providers submit claims for reimbursement for providing vaccines, they must ensure that Current Procedural Terminology (CPT) codes, developed by the American Medical Association (AMA), on the claim accurately reflect:
- the vaccine administered
- the appropriate vaccine administration fee, and
- any other service performed during the visit in which the vaccine took was administered (e.g. an Evaluation and Management (E&M) office visit code, or an upcode for other services provided)
With many opportunities for error, immunization providers often submit inaccurate immunization reimbursement claims because they do not know how to properly code for vaccines and the services associated with providing them. If the claims that providers submit to health insurance plans are not correctly coded for immunizations, health insurance plans, based on the best data they have available, may inadvertently under-report immunizations thus lowering their HEDIS scores, or will need to conduct expensive chart reviews.
To locate and rectify these inaccuracies, and obtain a correct assessment of immunization rates, health insurance plans often need to conduct chart reviews, which increases costs for the insurer, the provider, and the patient. Some health insurance plans offer education tools to their providers to address this barrier to accurate immunization reporting.
In this AHIP Virtual Seminar, participants will learn about a new online tutorial that walks providers through the tricky terrain of accurately coding reimbursement claims for the vaccines they administer. This tutorial was developed by a pediatrician who works for a health insurance plan and serves on the AMA committee that defines CPT codes. The tutorial is being made available to AHIP member health insurance plans. See how a simple solution that meets the needs for educating providers about accurate vaccine coding without requiring major systems investment can raise HEDIS scores, lower healthcare costs and improve provider satisfaction.
Virtual Web Seminar July 16 Online Tutorial for Vaccine Providers: Accurate Claims Coding
Carla Espinoza, LVN, CPHQ
Healthcare QM Manager
Aetna Informatics National Quality Management and Measurement (NQMM)
Joel Bradley, MD, FAAP
Associate Medical Director
Americhoice by United Health Care
Support for this program was made possible through an unrestricted educational grant from sanofi pasteur, the vaccines division of sanofi-aventis Group.
The content presented in this audio conference is solely attributable to the speaker and does not represent an endorsement by America's Health Insurance Plans (AHIP) of the accuracy of the information presented in the audio conference or any opinion expressed by the speaker.
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