CAP’s My Practice program has received several calls from CAP members about COVID vaccine reimbursement and denials, as there has been much confusion on how to bill. As if the pandemic hasn’t been stressful enough due to income loss and other challenges, billing has become even more difficult to navigate.
The guidelines for billing for COVID vaccine administration vary based on payor type and if the physician is participating in the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program. Physicians who have opted to participate in this program have contractually agreed not to seek reimbursement from patients. However, health plans and insurers are required to reimburse for the administration of the COVID-19 vaccine regardless of whether the physician is in or out of network with the health plan.
Additionally, there are nuances in billing within each payor that may require a different way to submit claims than billers are accustomed to.
Fortunately, The California Medical Association (CMA) has created several helpful resources:
CMA’s COVID-19 Vaccine Reimbursement Quick Guide: Download Now
CMA Covid Vaccine Toolkit: Download Now
Additional Information from Physician News Network: Learn More
My Practice is CAP’s free practice management and business services solutions program. In addition to being available for general practice-related inquiries, My Practice can provide you with additional resources to navigate reimbursement and billing issues.
To learn more, contact Andie Tena, CAP’s Director of Practice Management Services, at ATena@CAPphysicians.com or via phone at 213-473-8630.