With the recent approval of the two new COVID-19 vaccines from Moderna and Pfizer-BionTech users of the Practice Partner, Medisoft Clinical and Lytec MD EHR's need to add both vaccines to their Health Maintenance templates.
AVS Medical has created this simple, step-by-step guide to show how to add the Pfizer and Moderna COVID-19 vaccines to Health Maintenance in your Practice Partner, Medisoft Clinical and Lytec MD EHR.
Simple 3 Step Process - Overview
Step 1: Create the vaccine manufacturers names in List Maintenance Templates
Step 2: Create the Health Maintenance Names for each vaccine
Step 3: Add the Health Maintenance names to each of your Health Maintenance Templates
3 Step Process - Detailed View
Step 1 Create and add the manufacturer name in List Maintenance
The first step is to actually add the vaccine names to Practice Partner as follows.
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Go to Maintenance-> Templates->List Maintenance
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Find “Vaccine Manufacturer” in list and click edit
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Click New and add Pfizer in the name and description fields (leave Codes empty)
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Repeat the above step for the Moderna vaccine
step 2 - create the health maintenance name
Now that. you've added the vaccine manufacturers to Practice Partner you need to create the actual Health Maintenance names you're going to use as follows
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Go to maintenance->Templates-> Health maintenance Names->New
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Enter Pfizer Covid-19 in HM Name field
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Enter 208 in HM Code 1 field, enter "CVX" as Code type
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Enter PFIZER COVID-19 VACCINE in HM Cross Reference field
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Click the "More" tab
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Enter 0.3 ml as the dose
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Enter Intramuscular for the Route
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Enter Syringe for the Device
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Enter 208 as Vaccine Type
Adding Moderna Vaccine - Details
Follow the same process as above under the heading "Step 2", you'll use a different name, dose and different vaccine type for the Moderna vaccine
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Go to maintenance->Templates-> Health maintenance Names->New
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Enter Moderna Covid-19 in HM Name field
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Enter 207 in HM Code 1 field, enter "CVX" as Code type
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Enter MODERNA COVID-19 VACCINE in HM Cross Reference field
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Click the "More" tab
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Enter 0.5 ml as the dose
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Enter Intramuscular for the Route
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Enter Syringe for the Device
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Enter 207 as Vaccine Type
step 3 - adding health maintenance names to health maintenance templates
Now that you've added the vaccine names (step 1) and created the Health Maintenance Names (step 2) you'll add the Health Maintenance names to each Health Maintenance template for the Age/Sex that you'll be administering it.
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Maintenance-> Templates-> Health Maintenance Templates (Leave Provider ID blank)
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Select the Age and Sex template-> Edit
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Click “New Proc”-> Find Pfizer Covid-19 in the list
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Set to Do every 21 Days for 2 times -> Min Interval 21 Days
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Repeat for every Age/Sex Template that is applicable
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Repeat the process for Moderna if desired, using the same steps and frequency
If you want to Print the Immunization on the Immunization Form:• Maintenance-> Templates-> Form Templates-> Immunization Form
• Find “Pfizer Covid-19” in the HM Names and add it to the HM Immunizations
Billing Information, Additional Resources and References
Coverage and Reimbursement for Administration of the Vaccine by Health Insurance Issuers
• The vaccine itself will be paid for through funding authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, but administration of the vaccine by a provider will be paid for by the payer (for example, the private insurance company, Medicare in the case of a Medicare Advantage plan, or the Provider Relief Fund).
• Consumers enrolled in non-grandfathered group or individual health insurance coverage will be able to receive the vaccine and its administration free of charge from a network provider, and during the COVID-19 PHE, will also be able to receive the vaccine and its administration free of charge from an out-of-network provider.
• Providers are prohibited by agreement with the U.S. Government from billing patients for the vaccine or its administration, including balance billing.
Medicare Advantage Coverage and Reimbursement
• For Calendar Years (CYs) 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration for beneficiaries enrolled in Medicare Advantage plans will be made through the original fee-for-service Medicare program.
• Medicare Advantage plans should inform their contracted providers about this coverage policy and direct them to submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.
Issuer Coverage Out Of Network
• Pursuant to a recently issued Interim Final Rule by CMS and the Departments of Labor and the Treasury, issuers of non-grandfathered group or individual health insurance coverage are required to provide coverage, without cost sharing, for in-network qualifying coronavirus preventive services, including a COVID-19 vaccine and its administration, and during the COVID-19 PHE, from out-of-network providers as well.
• For network providers, issuers will typically pay negotiated rates. For out-of-network providers, issuers will typically pay up to an allowed amount. During the COVID-19 PHE, the amount an issuer reimburses a provider for administration of a COVID-19 vaccine out of network must be reasonable, as determined in comparison to prevailing market rates for such service; one example of reasonable payment would be the Medicare reimbursement rate
Vaccine Coding
• Medicare payment rates for COVID-19 vaccine administration will be $28.39 to administer single-dose vaccines.
• For a COVID-19 vaccine requiring a series of 2 or more doses, the initial dose(s) administration payment rate will be $16.94, and $28.39 for the administration of the final dose in the series.
• These rates recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine.
• These rates will also be geographically adjusted.
Vaccine Coding CPT Codes
CVX Codes
Setting up COVID Vaccines in Practice Partner - Depending on your workflow:
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Update the .H Dot codes in your note to reflect the Vaccine and appropriate data.
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Include the CPT codes to reflect the 1st vaccine and the 2nd vaccine.
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If you plan on administering the Vaccine check with your carriers for any policies they may have in place, including if you need to in order to submit claims.
Additional Resources
https://www.cms.gov/files/document/COVID-19-toolkit-issuers-MA-plans.pdf
