MIR-2006-10AB, October 2006

2006 - 2007 Influenza (Flu) Season Resources for Health Care Professionals

Provider Types Affected
All Medicare fee-for-service (FFS) physicians, non-physician practitioners, providers, suppliers, and other health care professionals who bill Medicare carriers/Medicare Administrative Contractors (MAC) or fiscal intermediaries (FI) for flu vaccines and vaccine administration provided to Medicare beneficiaries.

Provider Action Needed

• Keep this Special Edition MLN Matters article and refer to it throughout the 2006 - 2007 flu season.
• Talk with your patients about the flu virus and their risks for complications of the disease and encourage them to get the flu shot. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.)
• Stay abreast of the latest influenza information and inform your patients.
  • Order appropriate provider resources for yourself and your staff.
  • Have appropriate literature on hand about influenza that can be handed out to your patients during the flu season.
• Don’t forget to immunize yourself and your staff – Protect yourself, protect your patients, and protect your family and friends. Get Your Flu Shot.

Introduction
On average, 36,000 people in the United States die each year from influenza and complications arising from influenza. Greater than 90 percent of deaths occur in persons 65 years of age and older. Individuals with chronic medical conditions such as diabetes and heart disease are particularly at risk of influenza infection, as are people in nursing, convalescent, or other institutional settings.

Historically, the flu vaccine has been an under-utilized benefit by Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) needs your help to ensure that Medicare beneficiaries are informed about this vaccine-preventable disease and get their flu shot this flu season. In addition, unvaccinated health care workers can spread influenza to patients, family, and friends. CMS encourages you and your staff to get vaccinated. Protect your patients, protect your family and friends, and protect yourself.

CMS has developed a variety of educational resources, listed in the next section, to ensure that Medicare FFS health care professionals have the information they need to bill Medicare correctly for the Medicare-covered vaccines and help promote increased awareness and utilization of the flu vaccine among beneficiaries, providers, and their staff.

Products

• MLN Matters Articles
  • MM4240 ~ Guidelines for Payment of Vaccine (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) Administration http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4240.pdf
  • MM5037 ~ Reporting of Diagnosis Code V06.6 on Influenza Virus and/or Pneumococcal Pneumonia Virus (PPV) Vaccine Claims and Acceptance of Current Procedural Terminology (CPT) Code 90660 for the Reporting of the Influenza Virus Vaccine http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5037.pdf
• MLN Flu Related Products for Health Care Professionals
• Quick Reference Information: Medicare Immunization Billing ~ This two-sided chart provides Medicare FFS physicians, providers, suppliers, and other health care professionals with quick information to assist with filing claims for the flu, pneumococcal, and hepatitis B vaccines and their administration. This product is currently available as a download. http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf
• An Overview of Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ This educational video program provides health care professionals with an overview of Medicare-covered preventive services. The program includes a section on Medicare’s coverage of flu, pneumococcal, and hepatitis B vaccines. This educational video has been approved for .1 IACET* CEU for successful completion. This video program can be ordered through the MLN Product Ordering Web page. http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5
• The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ This comprehensive guide to Medicare-covered preventive services and screenings is intended to give Medicare FFS physicians, providers, suppliers, and other health care professionals information on coverage, coding, billing, and reimbursement to help them file claims effectively, while also giving providers information that will enable them to encourage utilization of these benefits as appropriate. Pages 97 – 104 cover the flu vaccine. Pages 117 – 119 include a discussion of mass immunizers and Roster billing. Available in print or as a download. http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf
• Medicare Preventive Services Adult Immunizations Brochure ~ This two-sided tri-fold brochure gives an overview of the coverage information for flu, pneumococcal, and hepatitis B. Available in print or as a download. http://www.cms.hhs.gov/MLNProducts/downloads/Adult_Immunization_06-08-05.pdf
• Medicare Preventive Services Series: Part 1 Adult Immunizations Web-based Training (WBT) Course ~ This course was updated in August 2006 and has been approved for .1 IACET* CEU for successful completion. This WBT contains four modules that include information about Medicare’s coverage of flu, pneumococcal, and hepatitis B vaccines. Module Four includes lessons on mass immunizers, roster billing, and centralized billing. This course can be accessed through the MLN Product Ordering Web Page. http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=1
• Quick Reference Information: Medicare Preventive Services ~ This two-sided laminated chart gives Medicare FFS physicians, providers, suppliers, and other health care professionals a quick reference to Medicare’s preventive services and screenings, identifying coding requirements, eligibility, frequency parameters, and copayment/coinsurance and deductible information for each benefit. This chart includes flu, pneumococcal, and hepatitis B. Available in print or as a download. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
• Medicare Preventive Services Bookmark ~ This bookmark lists the preventive services and screenings covered by Medicare (including flu) and serves as a handy reminder to health care professionals about the many preventive benefits covered by Medicare. Available in print or as a download.
  http://www.cms.hhs.gov/MLNProducts/downloads/medprevsrvcesbkmrk.pdf

• Other CMS Resources
  • CMS Adult Immunizations Web Page
    http://www.cms.hhs.gov/AdultImmunizations/
  • 2006 Administration Fees for Flu and Pneumococcal (PPV)http://www.cms.hhs.gov/AdultImmunizations/Downloads/
    0506vaccreimburs033006.pdf
  • CMS Frequently Asked Questions
    http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=I3ALEDhi
• Other Resources
  The following non-CMS resources are just a few of the many available in which clinicians may find useful information and tools to help increase flu vaccine awareness and utilization during the 2006 flu season.

• Advisory Committee on Immunization Practices http://www.cdc.gov/nip/acip
• American Lung Association’s Influenza (Flu) Center http://www.lungusa.org/ ~ This site provides a flu clinic locator http://www.flucliniclocator.org/. Individuals can enter their zip code to find a flu clinic in their area. Providers can also obtain information on how to add their flu clinic to this site.
• Centers for Disease Control and Prevention http://www.cdc.gov/flu
• Immunization Action Coalition http://www.immunize.org/
• Immunization: Promoting Prevention for a Healthier Life http://www.nfid.org/pdf/publications/naiaw06.pdf
• Medicare Quality Improvement Community http://www.medqic.org/
• National Alliance for Hispanic Health http://www.hispanichealth.org/
• National Foundation for Infectious Diseases http://nfid.org/influenza
• National Immunization Program http://www.cdc.gov/nip
• National Network for Immunization Information http://www.immunizationinfo.org/
• National Vaccine Program http://www.hhs.gov/nvpo
• Office of Disease Prevention and Promotion http://odphp.osophs.dhhs.gov
• Partnership for Prevention http://prevent.org
• World Health Organization http://www.who.int/csr/disease/influenza/en/

*The Centers for Medicare & Medicaid Services (CMS) has been reviewed and approved as an Authorized provider by the International Association for Continuing Education and Training (IACET), 1620 I Street, NW, Suite 615, Washington, DC 20006. The authors of the video program and Web-based training course have no conflicts of interest to disclose. The video program and Web-based training course was developed without any commercial support.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: SE0667
Related Change Request (CR) # N/A
Effective Date: N/A