I had the opportunity to meet with the Virgin Islands Medical Institute, AARP and Medicare beneficiaries, along with the press on February 25 and would like to clarify Medicares coverage policy for flu and pneumonia vaccines. People with Medicare can receive influenza and pneumonia vaccines at no cost. Although one pneumonia vaccine may be all that is ever needed, a flu shot is needed once a year. Medicare has not changed its coverage policy for flu and pneumonia immunizations and will continue to provide them at no cost to the Medicare beneficiary, if the doctor or hospital participates in the Medicare program.
Several billing errors were made by the company that processes and pays Medicare claims for Virgin Islands beneficiaries. In addition, the paper claims filed by one doctor were incorrectly coded and submitted. As a result, incorrect payments were made to the doctor and incorrect Medicare Summary Notices (MSN) were mailed to beneficiaries. Some MSNs showed that the provider was paid incorrectly and some showed that beneficiaries received more than one shot. The doctor notified CMS immediately about the incorrect payments and the error was resolved. The company that pays Medicare claims took several actions to fix the errors. Each beneficiary should have received a letter explaining the error and a corrected Medicare Summary Notice. Attempts were made to contact each affected beneficiary by telephone. The company has also taken immediate action to make sure these problems dont happen again.
CMS would like to take this opportunity to convey the importance of electronic billing to all Virgin Islands providers. Many billing errors can be avoided and claims can be processed expeditiously, generally within 14-30 days rather than the 27-30 days for paper claims. We also encourage Medicare providers to participate in training sessions conducted by the Medicare contractor and to call the contractor if they have questions on how to bill for a service.
We continue to strongly encourage all Medicare beneficiaries to take advantage of immunizations. Please be reassured that they can get flu and pneumonia vaccines at no cost. Once again, we offer our apology for the electronic snafu.
James T. Kerr
Region II Administrator
Centers for Medicare & Medicaid Services
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