Simplified Roster Claims for Mass Immunizers

10.3 - Simplified Roster Claims for Mass Immunizers (Rev. 13091; Issued:02-21-25; Effective: 01-01-25; Implementation: 07-07-25) The simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass pneumococcal and influenza vaccination programs offered by PHCs and other individuals and entities that give the vaccine to a group of beneficiaries, e.g. at PHCs, shopping malls, grocery stores, senior citizen homes, and health fairs. Effective December 11, 2020, roster billing is also available for billing COVID-19 vaccinations. Effective January 1, 2025, roster billing is available for hepatitis B vaccinations. If they agree to accept assignment for these claims, properly licensed individuals and entities conducting mass immunization programs may submit claims using a simplified claim’s filing procedure known as roster billing to bill for influenza virus, hepatitis B, pneumococcal or COVID- 19 vaccinations for multiple beneficiaries. They may not collect any payment from the beneficiary. Entities that submit claims on roster claims must accept assignment and may not collect any “donation” or other cost sharing of any kind from Medicare beneficiaries for pneumococcal, influenza virus, hepatitis B, or COVID-19 vaccinations. However, the entity may bill Medicare for the amount, which is not subsidized from its own budget. For example, an entity that incurs a cost of $7.50 per vaccination and pays $2.50 of the cost from its budget may bill Medicare the $5.00 cost which is not paid out of its budget. A. Provider Enrollment Criteria for Mass Immunizers Those entities and individuals that desire to provide mass immunization services, but may not otherwise be able to qualify as a Medicare provider, may be eligible to enroll as a provider type “Mass Immunization Roster Biller.” In addition, claims submitted by the provider type “Mass Immunization Roster Biller” are always reimbursed at the assigned payment rate. These individuals and entities must enroll by completing the Provider/Supplier Enrollment Application, Form CMS-855. Individuals and entities that enroll as this provider type may not bill Medicare for any services other than pneumococcal, influenza virus, hepatitis B, and/or COVID-19 vaccines and their administration. B. Payment Floor for Roster Claims Roster claims are considered paper claims and are not paid as quickly as electronic media claims (EMC). If available, offer electronic billing software free or at-cost to PHCs and other properly licensed individuals and entities. MACs (Part B) must ensure that the software is as user friendly as possible for the pneumococcal, influenza virus, hepatitis B, and COVID-19 vaccination billing.