Doctors’ Receive Cash Incentive for Vaccinating
In 2015, the physician then serving as liaison to the CDC’s Advisory Committee on Immunization Practices (ACIP) on behalf of the American Academy of Family Physicians (AAFP) wrote an article reminding fellow AAFP members that “minimizing costs and maximizing reimbursement can make immunizations profitable.” In addition to offering tips on how to be a “savvy vaccine shopper” and obtain manufacturer discounts for ordering multiple vaccines, the doctor discusses how physicians can make money on administration fees for pediatric vaccines by “properly coding for the service.”
He explained “proper coding”, which involves not just billing for the vaccine itself (and including a diagnostic code that “reminds the insurance company that this is part of the routine immunization schedule”), but also billing for the fee that “is supposed to cover the time, energy, and supplies required to administer the vaccine as well as the overhead associated with managing the vaccines.”
The good doctor then goes on to describe the pediatric vaccine administration codes that he considers the “most important” from a “financial point of view”:
These codes, which include a counseling component,…can be used only for patients 18 years old or younger. The reason these codes are so valuable is that they pay per vaccine component. For example, if you administer an MMR vaccine, you may bill for three components (measles, mumps, and rubella). If you administer a DTaP/IPV vaccine (Kinrix) you may bill for four components (diphtheria, tetanus, pertussis, and polio).
He notes that the codes were new as of 2011; prior to that year, combination vaccines actually resulted in lower rather than higher physician reimbursement.
What he didn’t mention in the article was the fact that some insurance companies provide “extra” incentive if a certain percentage of the children in the practice meet certain criteria such as “Combo 10” with the Blue Cross Blue Shield Network.
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