Vaccines, Inventory, and Billing

Next to salaries, vaccines are the single most expensive line item on a practice’s bottom line. They also can be a profit center if they are managed correctly. Are you following best practices and getting the most out of Office Practicum’s vaccine management? If you think someone else is “on top of this”, do your own evaluation to make sure you are OPtimized!

Vaccines should begin with maintaining appropriate inventory. It is amazing how many practices are not matching the vaccine names/CPTs with the immunizations they actually provide in their office. If the inventory is not set up correctly, there are potential errors in reporting to your vaccine registry and errors in reporting to the insurance company, which leads to an error in payment for what was provided.

Where do you find the CPT code? The package insert in the vaccine box is the best place to start. Make sure you associate the lot/box you have in the refrigerator with the appropriate CPT in the Vaccine Name Table. If you have a barcode scanner, use that to avoid errors. Remember, if you pick the wrong HIB or rotavirus vaccine, even vaccine logic will forecast incorrectly!

Next, make sure you document VFC vs. private stock appropriately. Enter the cost of your vaccine per dose so you can know how much your refrigerator is worth at any given moment AND so you can compare your payment to what it cost at the time you purchased the vaccine. Also, document the version of the VIS that you will be distributing for each vaccine.

VFC Stock

Depending on the size of your practice and the distribution of your refrigerators, many find it easier to limit the number of active lots available to choose from. This will help reduce the number of errors during the administration process. It is best practice to have your staff match the vial with the inventory and your order PRIOR to administration of the vaccine. Having limited active lots minimizes searching and scanning prior to vaccine administration and  helps to avoid errors when the staff realizes they didn’t pull the bottle for the vaccine you ordered. Doing data entry after the vaccine has been delivered doesn’t help you prevent avoidable administration errors.

Not sure how much vaccines should be costing you or whether you are getting the best deal? The best way to track this is to subscribe to the CDC’s private sector cost email service. Every time a manufacturer increases their cost, you will get an email alerting you to the update. Remember, the AAP business case for vaccines states that you should be receiving payment that is 17-28% above what you pay in order to break even. If you are looking for a way to reduce your cost, you may want to consider joining a vaccine purchasing group.

And remember, every time your cost goes up, make sure you adjust your fee schedule appropriately. Your biller should alert you any time you receive full payment for any item you bill. If you are getting 100% of what you are charging, it is very likely you are leaving money on the table and some insurance company might have been willing to pay you more. This is one place where you don’t want your overachieving traits from medical school to take over. Getting 80% of your charges is perfectly acceptable if your charges reflect what it costs you to provide plus profit.

Before your flu vaccine arrives, make sure you have good inventory practices and processes in place. Vaccines are the medical and financial cornerstone of pediatric practice. Vaccine management deserves your close attention.

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