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Resources: Flu Vaccines, Prior Authorization, and more

Posted by Admin Posted on Aug 06 2020

Apply Now: CARES ACT Provider Relief Fund Application Portal Now Open for Certain Medicare Providers

The U.S. Department of Health and Human Services (HHS) is distributing payments in the Phase 2 General Distribution of the Provider Relief Fund as part of ongoing efforts to offer financial relief to providers impacted by coronavirus disease 2019.  

Click here for details.​


Allocations of CARES Act Provider Relief Fund for Nursing Homes

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of the next CARES Act-authorized nursing home Provider Relief Fund (PRF) distribution.  

Click here for details.​


Flu Vaccine Amounts have been published for 2020-2021 Season

The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department. When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost. Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.   

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Effective with dates of service beginning 8/1/2020, prior authorizations will resume with the exception of Behavioral Health and Substance Use Disorder (SUD) services. Behavioral Health and SUD services are defined as services provided by any Behavioral Health Provider type (02, 03, 04, 05, 06, 23, 26, 30, 62, 63, 66, 67, 81, 82, 83, 84, 89, 92), services listed on the Behavioral Health and Substance Abuse Services Inpatient and Outpatient fee schedules, and services listed on the Community Mental Health Center (CMHC) Mental Health Substance Abuse Codes and Units of Service fee schedule.  

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