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Medicare Addresses Payment Concerns Related to H1N1

Cheryl Clark, for HealthLeaders Media, August 28, 2009

To answer questions about how to give and get reimbursed for care during a disaster, federal health officials have issued an extensive and updated list of answers to 132 questions on topics ranging from H1N1 influenza to mental health counseling.

"The timing is very appropriate because not only is hurricane season here, but we're preparing for questions coming in on H1N1," says an official for the Centers for Medicare and Medicaid Services, who said the agency's policy does not let him be quoted by name.

The official adds that the agency assembled the questions in one place so that providers would not have to search for the answers in a large manual. "These are real questions from real providers."

The answers respond only to what is appropriate without a federal declaration of emergency, called an 1135 waiver.

For example, it explains that CMS will reimburse providers for administration of vaccines for both seasonal and Novel H1N1 vaccines, but if the federal government provides the individual vaccine doses at no charge, the providers may not be reimbursed for the vaccine's cost.

Another questioner asked, "Will it be possible for providers enrolled in mass immunizers to roster bill Medicare for H1N1 administration as they do for seasonal flu?" a process by which an entity that administers vaccines to large groups of people can submit one claim for treating 500 patients.

Answer: "Yes."

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