Administer A Flu Shot, Earn A $20 Payment!
Rates of hospitalizations and deaths due to influenza continue to remain consistent year over year. Despite this, flu shot rates are continuing to decline. In an age of misinformation about the flu shot, it’s important now, more than ever, to ease any doubts the public might be having about getting the flu shot.
While we at CareSource can share education with our members on flu shot safety, there’s only so much impact that can have. This is why we’re turning to you for help.
According to a survey we recently administered to our members, 60% of respondents indicated that they trust their providers when it comes to flu shot education. However, only 9% trust their health plan. You, as our provider partners, play an integral role in helping us move the needle on this important public health issue.
As a way to support you in our efforts to improve flu shot rates and overall health outcomes among our members, we’ll be rewarding you $20 for each flu shot you administer to CareSource DSNP patients in your practice! Here’s how you can start earning these payments:
STEP 1: LEARN ABOUT THE QUALITY ENHANCER PROGRAM
To start earning flu shot payments, we recommend you learn about our Quality Enhancer Program (QEP). We reward you for providing the following high-value services to CareSource DSNP patients, including flu shot at the top:
| Service | Payment | Qualifying CPT Code(s) |
|---|---|---|
| Flu Vaccine | $20 Payable once per patient per flu season | 90630; 90647; 90672; 90653 -90657; 90658; 90660-90662; 90664; 90666; 90667; 90668; 90673-90672; 90687 |
| Diabetes A1c CPT II Result | $10 Charge amount required on CPTII codes on claim to allow enhanced payment. Payable once per quarter per patient | 3044F, 3046F, 3051F, 3052F |
| Controlling Blood Pressure CPT II Result | $10 $5 charge amount required on each the Diastolic and Systolic CPTII codes on claim to allow enhanced payment. Payable once per quarter per patient in outpatient setting. | Systolic: 3074F; 3075F; 3077F Diastolic: 3078F; 3079F; 3080F |
| COA Functional Status | $10 Payable once per calendar year per patient | 99483; G0438; G0439 |
| COA Pain | $10 Payable once per calendar year per patient | 99483; G0438; G0439 |
| Annual Physical Exam | $25 Payable once per calendar year per patient | G0420; G0438; G0439: G0468 |
| Colorectal Cancer Screening | $20 Payable once per calendar year per patient. Limited to PCP or Gastroenterologist. | 45330, 45331, 45333, 45334, 45335, 45337, 45338, 45341, 45342,45346, 45347,45347, 45350, 45378, 45380, 45381, 45382, 45384, 45385, 45391, 44388, 44389, 44390, 44391, 44392, 44394, 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45378, 45379, 45380,45386, 45388, 45389, 45390, 45392, 45393, 45398, 74261, 74262, 82270, 82274, 81528, G0104, G0105, G0121, G0328 |
| Breast Cancer Screening | $20 Payable once per calendar year per patient. | 77055-77057; 77061-77063; 77065-77067; G0202; G0204; G0206 |
| Diabetes Retinal Eye | $15 Payable once per calendar year per patient. Limited to CP or Ophthalmologist. Service. Trigger must be billed to CareSource to qualify for enhanced payment. | 65091, 65093, 65101, 65103, 65105, 65110, 65112, 65114, 67028, 67030, 67031, 67036, 67039, 67040, 67041, 67042,67043, 67101, 67105, 67107, 67108, 67110, 67112, 67113, 67121, 67141, 67145, 67208, 67210. 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92134, 92225, 92226, 92227, 92228, 92230, 92235, 92240, 92250, 92260, 99203,99204, 99205, 99213, 99214, 99215, 99242, 99243, 99244, 99245 |
| Member Engagement and Medication Reconciliation within 30 days Post D/C | $10 Payable three times per calendar year per patient. | 99495; 99496; 99483 |
*This chart and the corresponding payments are only applicable to high-value services that are delivered to CareSource DSNP patients in your practice.
To learn more about the QEP, work with your Health Partner Network Manager, or call Provider Services at 1-833-230-2176.
STEP 2: DISCUSS FLU SHOT WITH CARESOURCE PATIENTS
Do you have any upcoming appointments scheduled with CareSource patients? If so, we ask that you consider discussing the flu shot and flu shot safety with them during their visit. For reference, we are sharing this flu shot education with all CareSource members who are hesitant about getting the flu shot.
If any CareSource patients are on the fence, having a one-on-one discussion could be a great opportunity to put their minds at ease and offer the reassurance they need to finally take this vital step towards staying healthy.
STEP 3: IF POSSIBLE, OFFER SAME-DAY FLU SHOTS
We recommend offering same-day flu shots in your practice. This helps remove any potential time lags and barriers your patient may have with scheduling follow-up appointments.
Don’t have a flu vaccine supply?
We understand that you may not be able to administer flu shots in your practice. If this is the case, please refer CareSource patients to Find A Pharmacy*. They may also call us at 1-833-230-2020 (TTY: 711) and we will help them find transportation to a pharmacy.
* Please note: We cannot reimburse your practice for flu shots administered by a different provider/pharmacy.
Once your CareSource patient has gotten their flu shot, we urge you to please talk to them about the CAHPS survey they will be receiving sometime in February and make them aware that there will be a question there around the shot.
STEP 4: SUBMIT CLAIMS FOR REIMBURSEMENT
When you are ready to submit claims for the flu shots you’ve administered, make sure you use the following Qualifying Service CPT codes:
- 90630
- 90658
- 90667
- 90647
- 90660-90662
- 90668
- 90672
- 90664
- 90673-90672
- 90653-90657
- 90666
- 90687
STEP 5: EARN YOUR PAYMENTS
Once your claim submissions have been processed and we receive notification of it, you will earn a $20 payment for each flu shot claim you submitted!