DOS: 1/25/10: Patient goes to Drexel Clinic, has history of shingles, doc suggest Zoster vaccine. Clinic orders vaccine from local pharmacy, administers vaccine, bills medicare.
Claim is denied under medicare parts A/B since it came from a pharmacy.
They are saying the patient needs to file with his part D, but the only information they can supply is a "medical claim" form with procedure codes, etc. but no information about the vaccine.
I've got a call into the clinic to see if they will put me in touch with the pharmacy to see if they will file this under the patient's part D plan and then forward the payment to the clinic...
Other than that I'm leaning toward telling the patient to not pay the claim. The clinic should have never had the vaccine. Proper procedure is to have the patient go to the pharmacy, get the vaccine, self administer or bring back to the clinic for assistance.
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Jeebus... 88 views and no suggestions?
Claim is denied under medicare parts A/B since it came from a pharmacy.
They are saying the patient needs to file with his part D, but the only information they can supply is a "medical claim" form with procedure codes, etc. but no information about the vaccine.
I've got a call into the clinic to see if they will put me in touch with the pharmacy to see if they will file this under the patient's part D plan and then forward the payment to the clinic...
Other than that I'm leaning toward telling the patient to not pay the claim. The clinic should have never had the vaccine. Proper procedure is to have the patient go to the pharmacy, get the vaccine, self administer or bring back to the clinic for assistance.
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Jeebus... 88 views and no suggestions?
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