Covid Vaccine Workflow

I’m curious how many pediatric practices are registered and currently giving Covid vaccines to either patients or community members.

I would love to know how you’re handling workflow, billing, etc?

Anyone out there up and running successfully with this?

We are giving COVID vaccines to community members, patients. And parents. We have tried to work into daily workflow, but prefer Saturday clinics (we do not usually have weekend office hours), drive up, stay in your car, and we come to you.

Eligibility does not open to general population here for another couple weeks. But then we plan to have larger events at our high schools. Looking good so far, we will see what uptake is. We are in a rural area with poor vaccine compliance in good times.

Our local Health department has handled supply and distribution of vaccines to individual clinics. This includes vaccine, syringes, needles, alcohol stores, and even masks and face shields. They are also reimbursing $75 for each injection given. If you bill Medicaid or insurance you cannot be reimbursed by county. If you give injections to persons living outside the county they do not qualify for $75 and you may bill, however, we have considered those our community service and not bothered with insurance. It is not usually more than the bonus doses we have gotten from being efficient with drawing up vaccines. They have not been large in number.

We do not enter orders into our EHR, but do scan the vaccine administration forms to their chart. Our state vaccine registry is super simple to enter data into, so upload the dose information this way (must be reported within 24 hours). I can do 120 per hour on this system.

Now for the shocker. We run at very low staffing since quarantine started. We are 2 NPs with 3.5 staff. We, the NPs have done all of the scheduling, managing doses, injections, and weekend clinics for the covid vaccine special projects. My son and his friends manage traffic control and paperwork ( they -4 are high school juniors, this really gives them joy to be doing something to get back to school. We are still distance learning). We have a previous MA who has helped some with injections, she needs volunteer time to get into nursing school.

For scheduling I got cell phones to use that are not our usual numbers and an email to send paperwork (VAR, EUA VIS, and appointment confirmations as well as directions). It could be another if our EHR wasn’t Allscripts, but I’m process of chaging over to PCC, so if we are still doing these clinics when that happens I imagine our flow will improve significantly.

These are not large events. Initially we volunteered at the mass events by county HD where e could give 2000 per day and had many volunteers. These stopped and they asked individual clinics to engage. Our first weekend was only 54 doses. Our weekdays, only 11 per day. Our average will be about 120 per week. Our thoughts, if we all do a little, together we do a lot.

There are clinics doing 500 to 1000 doses per week, but there has been a struggle finding enough patients. We are trying to be oh so careful to have zero wasted doses. So far with our tight quality control this has been the easy part. This was not true at the larger events.

This is not a business model for our clinic as it has been for some others in our community. We are keeping small. Focus on quality. Hoping to make our small corner of the world a little safer for the Littles who can’t be vaccinated yet.


Doing our first one next week. Trying it on Friday 4/9. Doing it outside/drive thru. Will post after we do it.

We started doing them for our patients (18 and older) and the surrounding community. We gave 300 doses last week over three half days. We are billing their insurance, if they have one, for the admin. It is swift and efficient to give vaccines to willing adults. We are making an appointment for the second dose before they leave to cut down on incoming phone calls.

Do you have a specific consent form for those who aren’t your patients?

Are you making charts for each patient in your EMR for COVID vaccine administration? Do you have an intake and consent form you could share?

We’ve been giving COVID vaccines since February - started with 75 yrs and up in February, and now down to 16 yrs and up. We’ve given over 7,000 vaccines so far! Most have been in large mass events on Saturdays where we can give over 1,000 at a time. We also have a smaller clinics during the week of 200 or so. These are all drive-through clinics. We have been putting them in our EHR so that billing is easier, it goes to our VIIS automatically, and patients get appointment reminders.
The drive through clinic is actually the “easiest” part of this. The registration and insurance information collection (which we do prior to the event via Docusign) and the post-vaccination notes is still a cumbersome and we are trying to figure out how to streamline this process.

Are you getting paid by Medicare, yet? I know a number of practices who were able to get credentialed quickly, but even the fastest clearinghouse is going to take 60-90 days most of the time. I haven’t heard of any pediatricians getting Medicare $$ yet.

We have been community vaccinators since January. We registered with Medicare as a Mass Immunizer and have been receiving payments from them since early March. Almost all of our vaccinations have been outside as a drive-thru (there have been some very COLD Saturday mornings so we are looking forward to spring). Last month, we did some small in-office vaccine clinics during our office hours but find that it is not as effective as the drive-thru. We can vaccinate 10x more people through the drive-thru, plus patients are safer staying in their own environment and we don’t use as much PPE and cleaning supplies.

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Good to know! We are trying to figure out if in office or drive thru is the best way. How do you handle the 15 minutes wait time? Do you have someone that checks to see if their time is up or you just leave it to them to monitor the time and then leave?

Yes! We registered as a mass immunizer through our MAC (Medicare Administrative Contractor) back in February. Only just now getting payments for our early February clinics (partly MAC issues, partly us learning how they want the claims filed). Unfortunately, our MAC wants our roster for claims on paper HCFA forms. We figured out a way to automate the completion of the paper forms, but it’s still via snail mail.


Also, for the 15 (or 30) minute wait time, we have them wait in our parking lot. They self-time. We have providers walking around checking on people (esp the high risk cars). We mark the high-risk cars with a bright pink sheet of paper on the windshield. We have a “crash cart” nearby with oxygen, epipens, benadryl, albuterol, BP cuff, fluids, glucometer, stethoscope, pulse ox. We have had one anaphylaxis (out of the 6,000 doses given so far) and had to call EMS. We tell people to honk their horn if they are not feeling well.

We have found the drive-thru is very smooth. We have 3 stations. Station 1 is Check-In with Clerical. At the clerical station, we review a copy of the handout they will be provided by the physician, check them in to our system, have the driver show us where their hazard lights button is, and also place a car number on their windshield (this # identifies 1st or 2nd doses and/or different vaccine (Pfizer/Moderna)). Station 2 is with the MD, who goes over allergies, how long their wait time is, and what they should expect as potential side effects. Station 3 is the nurse, who gives the vaccine. For 1st does clinics we have an appointment every 2.5 minutes. For 2nd dose clinics we have an appointment every 2 minutes.
We do have them leave when they have reached the end of their observation time. We periodically walk through the observation area and check in with a thumbs up. If I can figure out how, I will attach a copy of the handout we provide.

Completely agree that drive through is the way to go - if you have the facility. At our drive through we can do 120-150 shots per hour with 2 lanes. Appointments are 1 minute apart per car. In the clinic we can do 100 in an 8 hour day. We did about 300 shots in 3 hours yesterday in the drive through.