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Unclear Expectations

“Balancing the needs of the various areas will be tricky at times,” Dr. Wright says. “We have to move people around while making sure we are not leaving one area dangerously understaffed.”

Education Imperative

Educating health workers is of the utmost importance before and during the flu season. A wide range of staff training will be required: reinforcing cough etiquette and hand-washing requirements through completely new procedures. This will be important for patient treatment and patient safety, two areas that intersect in hospitalists every day. In addition, this flu season will require a heightened level of personal responsibility from health workers. “Teaching needs are adding to the burden,” says Skoglund, the administrative director at Scripps. “Unfortunately, it is not as simple as sending out a memo to the staff and affiliated physicians.”

Training is a moving target, at least initially. Clinical employees will need to be trained on treatment and prevention guidelines as they are released, with special emphasis on keeping up with changes as the season progresses and lessons are learned.

“In the past, the CDC suggested using a N-95 respirator for all patients with novel H1N1,” Dr. Schiopescu says. “Currently, that has changed to approved use of a regular surgical mask, unless performing intubation or bronchoscopy.”

Despite the best efforts of the CDC, WHO, and other health organizations, there is no real clear idea of what to expect during the next flu season.

“What is known is that the hospitalist will be on the front lines, involved in the treatment of the sickest patients,” Dr. Wright says. TH

Kurt Ullman is a freelance writer based in Indiana.

Image Source: MAMMAMAART/ISTOCKPHOTO.COM

References

  1. Officials lower expectations for size of first novel flu vaccine deliveries. Center for Infectious Disease Research & Policy Web site. Available at: www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/aug1409vaccine.html. Accessed Aug. 20, 2009.
  2. Pandemic (H1N1) 2009: update 61. WHO Web site. Available at: www.who.int/csr/don/2009_08_12/en/index.html. Accessed Aug. 24, 2009.

More H1N1 Information:

Bookmark these Web sites to stay up-to-date with flu information:

Urgent Preparedness Initiative:

Medicare’s H1N1 Influenza Vaccination and Related Issues

Medicare fee-for-service policies and procedures for emergencies or disasters also apply to the H1N1 emergency.

Question: Will CMS release a letter or written statement to beneficiaries and providers stating Medicare’s intention to cover H1N1 administration through Part B and reimbursement rate, if known?

Answer: Yes. Presently (September 2009), the information available to CMS is that the H1N1 vaccine will be made available without charge to hospitals and physicians. If that is the case, then Medicare fee-for-service will not pay for the H1N1 vaccine. However, Medicare will pay for the administration of the vaccine in accordance with existing rules.

Q: Will reimbursement for H1N1 vaccine administration be the same as for seasonal influenza?

A: Yes. Multiple payments for administration will be available if the H1N1 vaccine requires multiple doses.

Q: What Medicare billing rules apply to administration of the H1N1 vaccine?

A: In general, it will be similar to billing for the administration of the seasonal flu vaccine. The major difference is that if the H1N1 vaccine is made available to providers free of charge, then Medicare will not pay for the H1N1 vaccine. Therefore, the HCPCS code for the vaccine need not be included on the bill/claim submitted for payment of the administration of the vaccine. The HCPCS code for the administration of the H1N1 vaccine is: G9141-Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family). Payment for G9141 will be made at the same payment rate established for G0008 (administration of influenza virus vaccine) for each administration.

Q: How will Medicare billing systems account for the possibility of multiple claims for influenza vaccination in the same season?

A: Medicare systems will be programmed to pay for both a single dose of the seasonal flu vaccine and its administration and for one or more administrations of the H1N1 vaccine (but, again, not the H1N1 vaccine itself if it is supplied to providers free of charge), and payment will be subject to normal billing and payment rules that apply to influenza vaccine.

Q: Will it be possible for providers enrolled as mass immunizers to roster bill Medicare for H1N1 administration as they do for seasonal flu?

A: Yes.

Q: States are distributing drugs from the CDC’s Strategic National Stockpile (SNS) to hospitals. How should hospitals handle billing for services that involve the use of SNS provided drugs?

A: Standard Medicare FFS billing rules apply. This would include following existing policy on no-cost items, such as SNS drugs. Hospitals and other providers should work with payers to determine the acceptable way, if any, to bill those payers for services related to free drugs/tests.

Q: Will Medicare pay for diagnostic tests for H1N1 flu for beneficiaries?

A: Medicare Part B covers diagnostic tests as set forth in 42 CFR 410.32 and other existing policies. Note, however, that the Social Security Act excludes payment for any item or service that was provided free of charge or if neither the beneficiary nor any other person is obligated to pay for such item or service, or if another federal entity is obligated—directly or indirectly—to pay for such item or service.

Q: Will Medicare cover and pay for a surgical mask to prevent the spread of/infection from H1N1 flu, if prescribed by a physician?

A: No.

Source: Centers for Medicare and Medicaid Services.

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