BACKGROUND:
Pneumococcal disease and influenza together are the fifth leading cause of death in the United States among persons aged 65 years or older.
Coverage for preventive services in the Medicare program has been added since 1980, and use of preventive services has increased over time. These preventive services include three types of immunizations: pneumococcal, hepatitis B, and influenza.
U.S. immunization rates have increased but have far to go. In 2002, 64.6 percent of persons aged 65 years and older had received a lifetime pneumococcal vaccine. In 2002, influenza immunization rates for this group were 69 percent. Healthy People 2010 targets both vaccination rates to reach 90 percent for persons age >65 years.

OBJECTIVE:
This workshop will provide answers to commonly asked Medicare billing questions, including roster billing, reimbursement, HIPAA and other new developments from CMS.

METHOD:
Trailblazer Health Enterprises (Medicare Carrier), CMS and Quality Improvement Organization (QIO) staffs will present an overview of Medicare reimbursement for influenza and pneumococcal vaccination. Program content and handouts will provide information on Medicare provider enrollment; roster billing; Standing Orders regulation; reimbursement; Health Insurance Portability and Accountability Act (HIPAA); and local QIO resources for improving immunization rates.

RESULT:
We hope to encourage those attending this session to use roster billing and implement Standing Orders in order to increase the numbers of Medicare beneficiaries that receive their annual flu vaccination and lifetime pneumococcal immunization. We will provide practical information and provide resources that participants can use to successfully roster bill Medicare for immunizations.

CONCLUSION:
Easier claims submissions.

LEARNING OBJECTIVES:
• Increase participants' understanding of Medicare provider enrollment.
• Increase participants' knowledge of billing Medicare for vaccinations.
• Increase participants' knowledge of Medicare reimbursement issues.
• Increase participants' knowledge of Standing Orders and implementation.
• Increase participants' knowledge of QIOs and their role in increasing adult immunizations.