2011 Immunization Admin Review

Here’s a little glimpse behind the magic curtain.

Usually, I’ll stew at my desk at work or when driving home thinking about some pediatric issue that’s bothering me.  After a while, if I get some free time, I’ll do a little research and see if I can reach a useful conclusion that’s worthy of sharing with others.  I have a lot of resources at my disposal here at PCC…but, often, I turn to Igor to help me with the research.

Recently, I’d asked him for some data about the immunization admin usage among PCC clients and I think he got sick of waiting for me to review it, so he did it himself.   I won’t bother rewriting his comments to pretend it’s my work, here’s Igor! My comments are highlighted.

– 77% (119 of 155) of our pediatric clients use the new admin codes. [Definitely higher than I would have guessed!]

– For the clients who use the codes, most are using adequate prices:
AVG charge amount for 90460 = $38.05 = 166% of 2011 Medicare rates
AVG charge amount for 90461 = $23.22 = 203% of 2011 Medicare rates

– For the clients who are actually getting paid for the codes, most are getting paid extremely well:
AVG dollars collected for 90460 = $19.64
AVG dollars collected for 90461 = $10.48

To put this in perspective, these collection amounts are in-line with what clients were getting for 90465 ($19.02) and 90466 ($11.31) in 2010.
– The catch to all of this is that most clients have some insurance companies who aren’t paying at all for the new admin codes. Some practices have had all of their claims held! [We can easily identify the payers who are causing problems.]

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