Quantcast
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

kansasgal

Full Member
2+ Year Member
Joined
Oct 9, 2017
Messages
51
Reaction score
37

Members don't see this ad.
Hi all! Quick question anyone work at a location that does not do part B billing?
The pharmacy I am at does not bill part B and because of this the PIC is convinced we can't bill part D for flu shots... This makes no sense to me. We don't bill part B for test strips so why are flu shots any different?
If the Part D won't cover the shot we get a rejection saying bill part B. Just out of curiosity I did a part D flu shot and it was covered with a $0 copay. But he won't even try once he sees the red, white and blue card.
Maybe I am missing something...

Anyone able to help?
 

Sine Cura

Membership Revoked
Removed
10+ Year Member
Joined
Feb 5, 2010
Messages
3,655
Reaction score
2,811
Some Medicare Advantage plans cover flu vaccine at the pharmacy, some don't... What does this have to do with whether you can bill part B? I am curious too
 
  • Like
Reactions: 1 users

kansasgal

Full Member
2+ Year Member
Joined
Oct 9, 2017
Messages
51
Reaction score
37
Some Medicare Advantage plans cover flu vaccine at the pharmacy, some don't... What does this have to do with whether you can bill part B? I am curious too
I have no idea...In my mind if the plan covers it they cover it. The PIC is paranoid that we are breaking some medicare rule by billing anything but B for vaccines...and he won't even try to bill the advantage plan.
Don't ask me why because his logic makes no sense to me.
 

zelman

Full Member
10+ Year Member
Joined
Nov 27, 2009
Messages
3,722
Reaction score
3,499
Part D doesn't cover anything covered by Part B. However, Part C often does. There is no harm in trying to bill and seeing if they have an HMO plan.
 

kansasgal

Full Member
2+ Year Member
Joined
Oct 9, 2017
Messages
51
Reaction score
37
Part D doesn't cover anything covered by Part B. However, Part C often does. There is no harm in trying to bill and seeing if they have an HMO plan.
Thanks for the reply those are my thoughts exactly
 

maria1oh

Full Member
10+ Year Member
Joined
Jul 23, 2009
Messages
619
Reaction score
159
Maybe worried about chargebacks? If you bill part d and they have part b that will pay for it then you might get chargeback?
We once got a chargeback because patient residence value was not correct.
 

RxRetailRx

Full Member
2+ Year Member
Joined
Jul 18, 2017
Messages
74
Reaction score
20
Medicare part B covers flu and Pneumonia shots in my state (FL)
 

Lnsean

Full Member
10+ Year Member
Joined
May 26, 2009
Messages
2,369
Reaction score
1,636
you will get a charge back from part D if part B covers the flu shot. You can only bill part D if the patient has an advantage plan and that HMO covers the flu shot. this has happened to us before and we got multiple charge backs because techs didn't know better...even if the Part D adjudicated they will come back and tell you that it's your fault and take the money back. 99% of the part D plans know this and will reject you and tell you to bill part B .
 
Top