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Zostavax update 2018


Unintentional double claiming of two funded adult vaccinations given on the same day

When claiming for Zostavax and influenza vaccines given on the same day, via Medtech PMS, both vaccines are being automatically auto-billed (ticked) when only one claim should be made.

Medtech recommends practices untick the auto-bill function for one of the vaccines given. The advice is to enter the flu vaccine event first and have the auto-bill ticked for this entry, as this will ensure you receive reimbursement for the vaccine cost as well as the immunisation subsidy. Then enter the Zostavax event and untick the auto-bill box.

This method of unticking the auto-bill will require practices reinstate the auto-bill prior, or at the next claimable/billable event, when applicable (such as when only one vaccine has been given).

Medtech is working to find a solution so these vaccines can be grouped to generate only one claim, as well as keeping the existing option of individually generating a claim for each vaccine when given on different days. 

A solution may be some time away and we recommend practices follow the suggested workaround until further notice.

MyPractice PMS defaults to billing for only one vaccine when both are given at the same time. For other PMS systems, please check the function that occurs to create a claim and make sure you are only generating one claim onto your schedules. If this is occurring similarly to Medtech, enter and claim the flu vaccine event first.

The Ministry of Health is yet to advise on the over payment so this will be released as soon as it is known.

IMPORTANT - In recognition of the additional work required as of 4 June 2018 the Ministry of Health has agreed to an additional payment of $15 for general practices if Zostavax and Influenza vaccines have been given to the same patient during the same consultation.

Zostavax vaccine calls

The IMAC 0800 line has received a significant volume of calls relating to the introduction of the Zostavax vaccine (shingles, HZV) and the flu season. Please download the IMAC updated chapters for the immunisation handbook on zoster, influenza, and vaccines for special groups as these are essential for decision making. Table 22.2 in the Zoster chapter is very useful when reviewing patients on immunosuppressive therapy.

To assist providers with their pre-vaccination screening, IMAC has developed two resources.
  • Patient checklist for the shingles vaccine may be given to a patient to complete prior to their consultation, to highlight areas that may require further examination by the health professional prior to HZV administration. This does not replace the need for an informed consent discussion.
  • Health professional screening tool for the HZV vaccine is to help guide health professionals with their screening questions and the rationale for the questions. These tools do not replace the requirement for providers to complete an appropriate pre-vaccination check and informed consent process. 

Zostavax vaccine process management

The addition of the Zostavax vaccine to the adult schedule has prompted discussion about how best to manage this process well and safely. 

It is IMAC's view that it is clinically appropriate, and the best use of patient time, to offer Zostavax to eligible patients when they are attending for another service, such as the flu vaccine. 

We understand and support this view, but know each practice will have different resources and pressures, and we all want to keep patient safety at the top of the list. 

Extra resources for additional costs of administration would be nice, and whilst we will raise this at the PSAAP negotiations, this is only one issue of many that will be discussed, and the counter-argument is that only one administration fee is paid for other joint vaccination events such as those in childhood.

There are a number of points practices may consider.

  • Adding another vaccine to the schedule may be an added pressure on the practice, particularly for the authorised vaccinators. Consider celebrating the small wins and continue to support each other.
  • The IMAC webinar is very informative and comprehensive. It takes one hour, but is well worth watching. The webinar covers such things as fridge capacity, ordering, rationale for targeting this age group and many other issues raised by practices.
  • Use the resources you have been given from the vaccine supplier MSD and from the IMAC website. You may be able to use some of the slides from the webinar as well.
  • Use the pre-vaccination checklist as a visual prompt in your vaccination rooms.
  • Create a keyword which covers all the pre-vaccination checks.
  • Documenting "verbal informed consent" in your clinical records is perfectly acceptable (another keyword may be useful).
  • Share your great ideas with other practices - no one wants to reinvent the wheel - we'd love to hear them and share them through Pin Points.

If you need to chat, or you have some ideas you would like to share, let us know. 

For more information contact Pinnacle MHN medical director Dr Jo Scott Jones: drjo@pinnacle.health.nz or nurse lead Hilde Mullins: hilde.mullins@pinnacle.health.nz

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