Confessions of a Pediatric Management Consultant... Where fame and fortune await those who help keep pediatric practices alive and independent!

H1N1 Admin Reimbursement

Written by Chip Hart | Dec 10, 2009 4:02:30 PM

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 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+.

Interesting stuff.