Billing and Reporting Immunizations in Pharmacy Software

Alexis Selzler About The Author

Mar 9, 2016 6:30:00 PM

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This year marks 20 years since the APhA started the Immunization Certificate Training Program. In the 20 years more the 280,000 pharmacists have become certified in administering vaccines, making them even more crucial health care resources in their communities.

It only seems fitting that as the role of the pharmacist has evolved over the years so should the tools that help them effectively do their job. Your pharmacy software should be equipped to bill for dispensing and administering immunizations.

Billing:

Immunizations and vaccines should be filled in the same manner as other injectable prescriptions with one exception.

  • Bill for the cost of the vaccination
  • Bill for an administration fee

When you administer the vaccination you also charge additional fees for the administration. These fees can be based on complexity of administration, vaccine type and variance in provider type. When billing you should enter the specific billing information in the DUR fields.

Reimbursement varies by plan. For example, Medicare Part D covers administration cost as a component of the negotiated price for a Part D vaccine. It includes:

  • Dispensing fee (if applicable)
  • Sales tax (if applicable)
  • Vaccine administration fee
  • Vaccine ingredient cost

With a Part D plan, in general there should only be one copay.

Reporting:

Just like the requirements for which vaccinations pharmacists can administer vary in each state, so do the requirements for pharmacists reporting immunizations. Some states require no reporting at all. If you’re beginning an immunization program in your pharmacy, I encourage you to research your state’s requirements. You should also read this great blog by our friends at R.J. Hedges on other steps you should take when starting an immunization program.

Most pharmacy management systems are incapable of reporting immunizations for you. For some states they may make it easier for you by setting up an automated dispensing report based on the NDC that exports the information needed from your software and sends it to you daily. However, this is only possible with very few states.

Because of this it may be best to go with a third-party company like Script Management Partners (SMP) to help report immunizations. With the rapidly growing necessity and complexity of reporting to your states Immunization Information Systems (IIS) Registry, SMP has taken the steps to be a leader in this area. Not all states are currently requiring reporting to their IIS, but having a partner that is familiar with the regulations in your state is very important.  If you would like to learn more about what SMP can offer, check them out here.

Having an immunization program in your pharmacy is a good niche market to explore, especially if your community is lacking in trained health care professionals. However, like with all other additional pharmacy services, it brings added responsibility to bill correctly and report in compliance with your state’s laws. Make sure that your pharmacy software partner has the capabilities to help you find your niche market in this ever-changing pharmacy market.

If you’d like to learn more about how Computer-Rx pharmacy software can help you reach new markets let us know!

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