I had grand plans to keep track of all the different payers and publicize/shame many of them, but by the time the data came in…it was too late.
Still, how have PCC clients fared with the new H1N1 administration code?
Better than I would have guessed.
The bottom line is that PCC clients averaged $14.90 from insurance companies and $16.73 from patients when they billed for the H1N1. That’s actually higher than our clients average for the 90465 or 90471, at least when I looked at it last year.
Of course, the variance is large, but not entirely the fault of the payers. I might look at a state – like AZ – and see that 1/2 of our clients are using the Medicare Code (G9141) and getting paid a penny because they charged a penny…while their neighbors use the 90470 and charge $25 and get paid $20. Same procedure, two very different billing methods.
However, there are clearly some super-lame payers out there. A payer in NY – let’s call them United – might pay $25+ to one practice and then $7 to another in the same county.
The clear “winner” for our clients is Tufts, available to folks in Massachusetts, often paying is excess of $40 per H1N1 admin. Many of the payers in New England paid higher than the rest of the country, no question. $25-35+.