Late Night With Chip & Paulie (Episode 19)

@Chip and @Paulie were joined by Christopher Rizzo, MD, FAAP to talk about the latest on Beyfortus.

Here’s the slide deck:
Late_Night_E19.pdf (2.9 MB)

Heres’ the video:

I took a little time to comb through the comments and questions from last night and, with mild editing, have shared some highlights as well as some answers to questions we didn’t get to (care of Dr. Rizzo).

What to do when a payor asks you for your vaccine invoice:
Buy a single dose directly from McKesson and send them the invoice. It should be well above your GPO price. It’s an invoice…

Don’t forget the Ultra Cold Freezer needed for Pfizer. Not needed for Moderna

One of our PPV programs said the code For PCV 20 won’t close the quality gap for imm 10

I encourage docs advocating for hospitals to cover Beyfortus, to ask them to have risk management look at their exposure. The hospitals need to be prepared for “Was your child hospitalized or worse from RSV this year? Did your birthing hospital offer your child Beyfortus?“ Hospitals are a really deep pocket. In my humble opinion this is really a problem for hospitals.

Dr. Rizzo discussed using up to 24 months. CDC mentions 19 months.
Is Beyfortus used in the second year up to 24 months, or 19 months?
From C Rizzo/Sanofi: These are not that far apart. The approved FDA indication is for all infants (12 months of age) born during or entering their first RSV season. And for children up to 24 months of age who remain vulnerable to severe RSV during their second RSV season. Assuming a 5-month RSV season and let’s use Nov through Mar as the season. That means infants born in April or later would be entering their first RSV season in the fall. And those infants would be <8 months of age in November. Similar in the second season, children would be <20 months of age entering their second season. The only difference is the ability to catch-up infants and children who miss a dose at the beginning of the season. The FDA label would allow an 8 month in December who missed their dose at 7 months in November, to receive it at 8 months of age in December. The ACIP recs do not. The ACIP allows catch-up but only if the infant is still <8 months. So a 4 month old who missed their dose in November, shows up in January at 6 months, can receive a dose based on ACIP. Just shift the ages for the second season. I hope this is clear.

Are they covering it for the elderly?

From C. Rizzo/Sanofi: Beyfortus is only approved for children <24 months of age. Maybe this question is referring to the older adult RSV vaccines.

Could you have a special visit for giving Beyfortus? Too many mistakes can be made without a focused visit- perhaps blend with a lactation consultation?
From C. Rizzo/Sanofi: Nothing to prohibit a special visit.

How do you become a "deputized health department?
You need to ask your state immunization branch if you can be deputized- in general, you need to be far enough from the health Dept that it is a hassle for the family to make a second trip- I think we use roughly a 30 min drive in NC- this may vary by state

Is there any movement to allow hospitals to bill separately for Beyfortus
outside of the bundled payment?
From C. Rizzo/Sanofi: I have heard of a few rare instances where payers have “carved out” payment for Beyfortus from the DRG for birth hospital administration.

Which gives better protect to the baby? Maternal immunization or infant

From C. Rizzo/Sanofi: There are no head-to-head studies. Maternal vaccination provides protection timed to birth so babies born in the summer have protection but may not really need it. Beyfortus provides protection timed to the season when RSV exposure will occur. ACIP also acknowledges due to its longer half-life, Beyfortus efficacy may not wane as quickly as protection from a maternal vaccine. ACIP recommends maternal vaccination only for mothers expecting to deliver infants during the season. Even if the infant was born to a vaccinated mother, the ACIP recommends Beyfortus be given in certain circumstances (please check final MMWR publication once published) such as a) infant born preterm, b) infant born <14 days after mother vaccinated, c) pediatrician especially concerned about the infants, and d) unable to confirm mother received a vaccine.

Can Paulie please post the email address for Ken (couldn’t catch last name) if we r with Verdan and want to notify we are going with Prevnar 20 and want the paperwork to continue with the 5% gardasil discount thru June? Thanks!

Dr. Novy- I sent it to you via private message. Because the forum is indexed by search engines, I didn’t want his email address swept up, etc…anyone else who needs it, please PM me.


Regarding the Covid vaccine discussion: Have you heard any updates on the return policy for unused doses of Moderna? On soapm, I was seeing 10-15% only could be returned. The Moderna site still has their 2020 policy.

Breaking News: To be announced by the end of day today: Moderna minimum order for COVID vaccines will be one box (10 doses). The refund/credit policy is adjusted to 10%.

Details to come from your GPO at any moment.

IPMSO/The VerdenGroup will be contacting all their members with the necessary forms to continue receiving Merck product discounts if practices choose Prevnar20 versus Vaxneuvance by tomorrow morning…

This applies to all practices under IPMSO/The Verden Group and Main Street Vaccines contracts:

Key takeaway: “…your Gardasil discounts will not be changing at this time and will be in place at least until July 2024!”

Regarding the data Chip provided on per provider number of patients, payments and charges per year- if my NP doesn’t bill separately but through the MDs, should i be looking at rendering provider numbers individually or billing provider numbers that include our patients that she is seeing? I appreciate all this, as it gives me a benchmark from which to monitor my productivity. Thanks!

First, the numbers in question are all based on the clinician who provided the service. I am reluctant to refer to it as “rendering provider” because that gets mixed up into incident-to billing, which is rarely appropriate in pediatrics.

So, look at who did the work.

Thanks Chip! Physicians and NPs should be getting the same payment for services should they not?

I’d like to think so and if I were in charge, I’d make it so. But there are too many payors who treat NPs toa 15-20% discount, as we all know. Billing them as “incident-to” is a way to avoid the ding, but it’s usually not allowed by the payors and it’s often a matter of time before you get audited and have to give back a lot of money.

Unless you have a written guide from the payor giving you permission to bill NPs under the doctor’s name, beware.

I have trusted my billers on what we are doing, but i certainly don’t want to be doing something we shouldn’t. My practice is small so we all work together, but my NP is pretty great so can do alot on her own. Because we are small, our documentation of collaboration is probably lacking. I will talk with them.
If we credential our NP and start billing directly under her, will that trigger an audit? We have a busy successful practice and i definitely do not want to jeopardize that in any way
Thanks for your thoughts on this. I generally feel like i am pretty saavy at the business end, but it is tough to stay on top of everything. I appreciate all the webinars and support.

I am going to get on this asap on Monday to see exactly what we are doing, what our insurance agreements are, and get her credentialed of she isn’t. Going through the numbers really brought this to mind, so thanks again for sharing your wisdom.

I don’t know what the rules are in IL, but I would begin by looking up the incident-to and NP billing rules on each of your payor WWW sites. You can usually find the rules without a lot of effort. I am pretty sure that BCBS of IL does not allow it, for example.

One thing that many practices miss is that proper “incident-to” billing means that the NP can’t see any “new problems” or anything related to a “new or worsened complaint.” In other words, your NP can’t do most sick visits.

Don’t worry about triggering an audit. Just find out what the rules are for each payor - it’s likely you will get a couple different answers - and straighten it out. You might get the bad news that the payor is going to ding you 15%, but that beats an audit and having to write a big check.

Unfair? Yes. But those are the rules.

Thanks Chip.

As always, I appreciate the input. I look forward to seeing you at the PMI conference in February!

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