The Director - Fall 2011 - (Page 22)
issues for providers in that providers do not typically have a relationship for Part D plans, so obtaining reimbursement can be a challenge. There are programs to assist with this relationship so that Part D coverage is not a barrier to appropriate vaccination. In addition to the Parts B/D coverage for vaccines, there is also confusion regarding Medicare Part A. The basis for this confusion is the belief that all pharmaceuticals (including vaccines) are covered under the bundled Medicare Part A Subacute PPS payment to a nursing home. However, preventive services are never covered as Part A skilled nursing facility (SNF) services, even when furnished to a beneficiary during the course of a Medicarecovered SNF stay. Eliminating the Enemy Preventing the spread of infections in nursing homes is in many ways literately in nurses’ hands, from implementing good handwashing strategies to staying at home when sick. Beyond these needs, there continues to be a need for greater vaccination both of staff and residents. Getting to appropriate vaccination levels requires eliminating many misperceptions that exist in nursing homes. These barriers can come down through nurses using their hands and minds. In the end, the nursing home staff should not be the enemy in the fight against infectious disease but rather the leaders by example and through education. It is only through this approach that infectious disease can be improved within our nursing homes.
References 1. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Available athttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm. Accessed October 5, 2011. 2. Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Ann Intern Med. 1999;130:126-130. 3. Pittet D, Boyce JM. Hand hygiene and patient care: Pursuing the Semmelweis legacy. Lancet Infect Dis. 2001;1:9-20. 4. Boyce JM, Pittet D, et al. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morbid Mortal Wkly Rep. 2002;51(RR16):1-45. 5. Institute for Healthcare Improvement. How-to Guide: Improving Hand Hygiene. A Guide for Improving Practices among Health Care Workers. Available at: http://www.shea-online.org/Assets/files/IHI_Hand_ Hygiene.pdf. Accessed October 5, 2011. 6. Mayo Clinic. Antibiotics: Misuse puts you and others at risk. Available at: http://www.mayoclinic.com/health/antibiotics/FL00075. Accessed October 5, 2011. 7. Stefanacci RG. Creating Artificial Barriers to Vaccinations. JAMDA. 2005;7(1):357-358. 8. CMS Letter. Laurence D. Wilson, Director Chronic Care Policy Group, dated July 25, 2007 addressed to Ms. Wendy Krasner, Manatt, Phelps & Phillips LLC.
Vaccine Reimbursment Coverage
Part B Influenza, pneumococcal hepatitis B, tetanus Part B vaccines have the Part B payment cover the vaccine and administration in separate payments. Part D vaccines have the Part D payment cover vaccine and administration. Administration of these vaccines cannot be billed separately under Medicare Part B. Typically, a Medicare Part A stay includes a capitated payment to the facility/ organization which includes a bundled payment for medications; however, preventive vaccines are an exception. Preventive vaccines can be separately billed to Medicare under Part B or D, depending on the vaccine used.
All non-Part B covered vaccines, such as those
All preventive vaccines can be billed separately
22 The Director
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