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The Forum is alive Started by iamyoung at 07-07-2005 6:41 PM. Topic has 3 replies. ACAAI Forums » House of Delega... » House of Delega... » The Forum is alive

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07-07-2005, 6:41 PM iamyoung Joined on 07-01-2005 Posts 4 The Forum is alive To all delegates, This forum is alive and kicking. As soon as I figure out the bugs in using this thing - we are a "GO" in having some great discussions on important issues in your state. I have received some info in my email from two states : VA and MN Big problem of reimbursement from BC/BS and Anthem on IT I'll fill you in when I get more info and if the authors don't mind sharing their woes for some input from the rest of the membership.   Rose-Speaker HOD    Report

07-11-2005, 3:23 PM Jeff Schul Joined on 07-01-2005 Posts 2 Re: The Forum is alive Anthem (soon to be Wellpoint) is close to finalizing their policy for vaccine reimbursement in Virginia. They are adopting the Medicare "1cc aliquot" as the unit for reimbursement despite our concerted efforts to retain the current CPT definition which refers to the number of doses to be administered from a given vial. Further and also like Medicare, they will no longer reimburse for dilutions in the initial build up. Since many of us in Virginia run at 40-50% Anthem, you can imagine what the financial implications of this change might be. Since Wellpoint just acquired Anthem, I suspect this policy may well go national soon and will likely be picked up by other insurers in Virginia and other states. Some thought has been given to applying for a new CPT for dilutions and this may need to be considered. Jeff Schul AASV    Report

07-15-2005, 4:31 PM iamyoung Joined on 07-01-2005 Posts 4 Re: The Forum is alive I think that not only should the JCAAI   try to renegotiate a new reimbursement schedule for dilutions and cost of concentrated vials 95165 with Medicare, but that we should think of different strategies for billing. If you can't charge for the dilutions then one should have the extract companies make up your extracts and dilutions for a patient via prescription and charge cost to patient or have patient pay directly or via insurance - then you charge only for admininstration of IT. 95117 code. Of course I don't know how much the reimbursement would be for the manufacturers (ie Greer etc...), but you would be out of that loop of expense. the down side - any one could give the shots ( family MD , PMD vs us the allergy specialists). I know that the JCAAI are trying to get information from us on how much time, effort, expertise and expense goes into making up vials and diluting them down. to renegotiate the codes, but some of us also make up vials from stock dilutions instead of concentrate, as we build up, because of possible loss from no shows or people who quit midway.  The JCAAI didn't take into account the extra work and time it takes to make these vials up, because you are calculating a new vial everytime and not just diluting down. Different Codes?  Comments from the membership?   Rose-Speaker HOD    Report

07-16-2005, 12:25 PM Jeff Schul Joined on 07-01-2005 Posts 2 Re: The Forum is alive I would be very careful about moving the creation of the vaccine to the extract companies. This will only further accelerate the current movement towards making allergy vaccine a pharmacy benefit and not paying the prescribing physician for the supervision and management during the creation of the vial which is a part of the current coding. As you noted, it could also encourage a trend towards the remote practice of allergy which we have all been fighting for years.  I only know about one manufacturer, but ALK currently charge more than three times what Medicare pays for the initial set of dilutions.    Report

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