Reimbursement For Administrating Flu Shot

Reimbursement for the vaccine administration for home health agencies is based on the outpatient prospective payment system (OPPS) vaccine administration rate,
which is determined each calendar year (CY). The 2014 OPPS rate for the influenza vaccine administration is $29.50.This rate is in effect for CY  2014.

Sixty percent of the rate is wage adjusted using the hospital wage index  core based statistical area (CBSA). For home health agencies, vaccines are reimbursed  based on the reasonable cost.

To determine the amount the HHA will be reimbursed for the vaccine administration, the agency will need to use the hospital wage index that applies to the CBSA where the service is furnished and adjust 60 percent of the national unadjusted payment for vaccine administration by the applicable wage index.

In 2014, for example, the national unadjusted payment rate is $29.50.  If the hospital wage index for the applicable CBSA is .99, payment to the HHA will be $29.32

$29.50*.6=$17.70 (the portion to be wage adjusted); $17.70 *.99 (the wage index) =$17.523 (the wage adjusted portion of the payment) $17.523+$11.80 (the 40% of the national unadjusted payment that is not wage adjusted)= $29.32 (after rounding).

*Information above provided by NAHC

Also, nursing homes are mandated to offer the flu vaccine to their residents. If you have a nursing home resident on the hospice benefit, it is the nursing home’s responsibility to manage the payment and should not come out of your per diem rate.


3 thoughts on “Reimbursement For Administrating Flu Shot

  1. Pingback: Monday Morning Recap | hmsabc

  2. Do you have the way this is calculate? I cannot find the information that makes this calculation anywhere and I cannot find the NAHC web address where it is contained either.

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