As discussed in the Check-In videos, most of your patients will go through VaxCare's system as "Insurance Pay," meaning VaxCare will bill the patient's insurance to cover the cost of their vaccines and pay your office for administering them. This is certainly the preferred method of payment with VaxCare, because it's the only payment method eligible for our Risk Free Guarantee!
However, we know that we don't live in a perfect world, and sometimes your patient has an out-of-network plan or needs to pay cash for their vaccines. VaxCare created our system to work for your office, so we offer alternate methods of payment for these patients. A description of each method of payment is below.
Insurance Pay: This is the default method of payment on patient check-in and means that VaxCare will bill for both the CPT on the vaccine and the CPT on the administration of that vaccine. This also means, by nature, that your office does not bill for any portion of the patient's vaccines. It is very important to make sure your EMR is not automatically billing for the vaccines you administer, which would result in double-billing the patient's insurance policy. For help with turning off vaccine auto-billing in your EMR, please see the EMR Collection or contact your EMR rep.
Partner Bill means that you, as our partner, have elected to bill for your patient's vaccine(s) for this encounter. When you choose Partner Bill upon patient check-in, your office will bill for both the CPT on the vaccine and the CPT on the administration. At the end of the month, VaxCare will deduct the market cost of that vaccine from your compensation check, and you'll be reimbursed directly from the insurance company.
Generally, there are just 3 scenarios in which we would recommend this payment option: 1) The patient has an insurance plan that is not yet contracted with VaxCare, 2) The patient is knowingly receiving a vaccine out of age indication, or 3) The patient is receiving a vaccine because of a medical condition that would otherwise not be covered by the insurance company (i.e. 2nd tetanus vaccine in a 10-year-window due to a laceration).
Self Pay: This payment option is used when a patient does not have insurance coverage for their vaccines and/or they do not wish to give you their insurance information. Your practice sets your office-specific Self Pay rates, and then your patient pays your practice directly, at the time of service, for their vaccines. At the end of the month, VaxCare deducts the market cost of their vaccines from your compensation check.
Keep in mind that we provided our vaccines at no cost to your practice, so deducting the market value of the vaccine from your compensation is our way of recouping our cost, as you will be reimbursed directly from the insurance company (Partner Bill) or patient (Self Pay). You do not need to report your self-pay rates to VaxCare, but we do recommend you charge enough to at very least cover your cost of the vaccine.
Before your practice's Go Live Day with VaxCare, it's important to set the Self Pay rates for your office. It's super simple and is explained in our Help Center!
REMEMBER THAT COMPENSATION DETAIL REPORT?
Told ya it would come back during training! Recall that VaxCare's MONTHLY BEST PRACTICE is to reconcile the Compensation Detail report for your practice and bill for any outstanding vaccines for which VaxCare did not (or could not) bill. Outstanding vaccines may be a result of staff checking in a patient At Risk (against our recommendations) or as a Partner Bill or Self-Pay patient. This report is released on the 15th of every month and details exactly what contributed to, or deducted from, your compensation check for that month.
We have help articles about reconciling your monthly Compensation Detail report in the Help Center, but for now, just know that our Customer Care team reaches out to each of our partners with their first compensation check to review this process. If you are a new Office Champion for an existing partner, please reach out to Customer Care for assistance with reconciling your next Compensation Detail report (it's that important, we promise!).
As Office Champion or Billing Manager, we strongly encourage you to ensure that the reconciliation process is completed each month, and we encourage you to remind your staff of the importance of following insurance eligibility prompts. With VaxCare, the more the front desk and nursing staff follow the workflow processes we've set in place (which includes following eligibility prompts), the less work you have to do!
VAXCARE EXPECTATIONS FOR ALL PARTNERS
Now on to the less exciting, but oh-so-important details we have to mention to you. We expect that you understand the billing scenarios related to the various methods of payment as outlined above, and that you will reach out to our Customer Care team immediately as any questions arise.
If you accidentally file a claim for the same patient/vaccines/encounter for which VaxCare was supposed to bill (i.e. Insurance Pay doses), our expectation (according to our Terms of Service) is that you will remove your claim and/or reimburse the insurance company from which you have already been paid. If the amount cannot be reimbursed and VaxCare's claim was denied because of the double-billing, we will charge your practice for the cost of the vaccine(s) for that encounter.
Intentionally billing for claims that VaxCare has already billed (or is expected to bill, because the shots are listed as Insurance Pay upon patient check-in) constitutes insurance fraud and will be grounds for termination from our program.
And -- just a reminder -- VaxCare is not responsible for billing errors for vaccines given outside of our program billing guidelines above.
The default method of payment is Insurance Pay. By policy, who bills for the patient’s vaccines when they are checked in as Insurance Pay?
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