CMS Simplifies Hospice Vaccine Billing Effective October 2016 Change Sought by N
ID: 469774 • Letter: C
Question
CMS Simplifies Hospice Vaccine Billing Effective October 2016 Change Sought by NAHC, Forum of State Associations May 1, 2016 11:40 AM The Centers for Medicare & Medicaid Services (CMS) has just issued Change Request 9052/Transmittal 3503 which, effective October 1, 2016, allows hospices to bill Medicare for covered preventive vaccines (influenza virus, pneumococcal, and hepatitis B) directly on the institutional claim rather than requiring that they secure and maintain separate enrollment and bill vaccines as a Medicare Part B Supplier in order to receive payment. CMS references this change as providing “administrative simplification for both hospices and Medicare. If the services are billable on institutional claims, hospices will not need to maintain separate billing systems to create professional claim formats for vaccine services or to submit paper CMS-1500 claim forms for these services. The Medicare program will reduce the number of enrollments it must process and maintain. It will also reduce claims processing workloads for paper claim submissions.” Propose insights and recommendations to promote reimbursement for services offered by the provider organization. Discuss the implications for future supply and demand for services provided. Examples: A preventable fall results in non-payment to provider, inaccurate coding or untimely claim submission results in payment denial, or patient satisfaction scores deteriorate and CMS denies payment for provider services.
Explanation / Answer
Case facts:
The above case deals with the shift in the services provided which are intended directly on the institutional claim rather than requiring that they secure and maintain separate enrollment and bill vaccines as a Medicare Part B Supplier in order to receive payment.
The Medicare program will reduce the number of enrollments it must process and maintain. It will also reduce claims processing workloads for paper claim submissions.
Case problem:Discuss the implications for future supply and demand for services provided.
Case solution:
Any business decision would definitely influence the demand and supply operations. In the case discussed The Medicare program will reduce the number of enrollments it must process and maintain. It will also reduce claims processing workloads for paper claim submissions. The initiatives can be further increased to provide online sources of claiming the reimbursement and further promoting the awareness of various medical services to the near by locations. It should also include peak load offers where patient frequency can be more and near the hospitals.
It can also include various schemes towards rural areas and promote easier ways of claiming medical insurance.
implications for future supply and demand for services provided:
In any service organisation the overall quantity supplied can occur because of changes in capacity and technology, cost structure, prices of substitutes and complements and perception of future prices.
When over capacity occurs in any industry, the entire supply of that industry's product increases. When that happens producers are willing to deliver greater quantity of services for the same price. An increase in supply occurs when if there are numerous producers for a service for the same price.