For Specific Groups of People:

Billables Project for Health Department Immunization Services Reimbursement
Innovative Projects to Improve Reimbursement for Immunization Services in Public Health Department Clinics

The Billables Project is a CDC-funded effort to enable state and local health departments to bill insurance companies for immunization services provided to insured patients. Since 2009, CDC has given more than $20 million to 28 project grantees to assist them in developing plans that will enable them to begin billing for vaccine services. The money raised through such billing programs can be used to expand and improve state and local immunization services for both children and adults.

 

Developing Mechanisms for Billing

Projects to Improve Reimbursement and Reinvestment in Immunization Programs

Seventy percent of U.S. health department clinics do not bill health insurance plans for immunization services they provide, according to a 2001 study. This failure to seek reimbursement for these services results in missed opportunities to generate significant revenue – money that could be used to finance enhanced and vital immunization programs for children and adults.

The National Vaccine Advisory Committee (NVAC), which studied the financing of child and adolescent vaccinations in the U.S., recommends that “states and localities develop mechanisms for billing insured children and adolescents served in the public sector. NVAC also recommends that CDC provide support to states and localities by disseminating best practices and providing technical assistance to develop these billing mechanisms. Further, NVAC urges states and localities to reinvest reimbursements from public and private payers back into immunization programs.” Consult the NVAC meeting minutes for further details about this recommendation and the other NVAC vaccine financing recommendations.

CDC, through the federally legislated American Recovery and Reinvestment Act of 2009, began providing more than $6.5 million in 2009 to 14 program grantees to develop plans that will enable them to begin billing for vaccine services. 

Through the federally legislated Affordable Care Act, Prevention and Public Health Fund (PPHF), CDC is providing more than $13 million in 2011 to 14 additional program grantees to develop plans that will enable them to begin billing for vaccine services.  Half of the original 14 grantees have moved to the next step of implementing their plans, and the National Association of County and City Health Officials (NACCHO) is developing a tool kit to assist grantees with billing practices. 

Grantees are developing a public health action plan that will describe activities, protocols, and procedures needed to pilot, initiate, and sustain a successful billing effort within the immunization program. Specifically, they will:

1. Develop an executive summary of the proposed action plan.
2. Work with stakeholders to gain strong, active support necessary for developing a successful billing program.
3. Collect original data, if needed, to determine the scope of the billing plan and the expected benefits to their programs. The original data may include information such as the approximate number or percent of vaccination services provided to fully insured individuals, the health plans whose members are being served in health department clinics, and the primary care providers whose patients are being served.
4. Describe existing resources (financial, Immunization Information Systems (IIS), personnel, communications, etc.) that can support a billing program and discuss anticipated resources necessary to implement and sustain the billing program.
5. Describe any anticipated barriers or resistance and how they will be addressed.
6. Provide a final plan that describes appropriate mechanisms to bill private health insurance companies for immunization services provided to plan members. The plan must include the public health, financial, and other convincing arguments for implementing this program within the state.
7. New implementation grantees will launch their developed plans, and move them as close to full implementation (billing Medicaid, Medicare, and private insurance for administration fees and reimbursement for vaccine cost) statewide as possible. 

Resources

Billing Resources

• California's Immunization Billing Project Plan [5.33MB - 96 pages]
• Kansas Foundation for Medical Care Immunization Billing Stakeholder Group
• Department of Public Health Publications
• The Washington State Local Health Jurisdiction Immunization Billing Resource Guide [5.54MB - 192 pages]

Webinars

• Coding and Electronic Billing [.zip 16.5 MB - playtime 1:14:02] August 28, 2012
  Warning: Extremely large file so provided as "zipped" file for your convenience. Opens as a Windows Media Player file (.wmv)
  • Speaker: Barbara Lardy, MPH, Senior Vice President, Clinical Affairs and Strategic Partnerships, America’s Health Insurance Plans
  • Speaker: Wayne Rawlins, MD, MBA, National Medical Director, Racial and Ethnic Equality Initiatives, Aetna
  • Speaker: Katherine Abel, CPC, CPMA, CPC-I, CMRS, Director of Curriculum, AAPC
  • Speaker: Michele Darnell, Vice President, Secure Exchange Solutions
  • Speaker: Shannon Montgomery, Aetna Learning Consultant, Communications Production and Education, Aetna
• Strategies for Contracting with Health Plans for Vaccine Delivery [.zip 19.6 MB - playtime 1:29:30] July 23, 2012
  Warning: Extremely large file so provided as "zipped" file for your convenience. Opens as a Windows Media Player file (.wmv)
  • Speaker: Barbara Lardy, MPH, Senior Vice President, Clinical Affairs and Strategic Partnerships, America’s Health Insurance Plans
  • Speaker: Wayne Rawlins, MD, MBA, National Medical Director, Racial and Ethnic Equality Initiatives, Aetna
  • Speaker: Kate Reynolds, MHA, Enterprise Contract Manager, Provider Contracting and Reimbursement, WellPoint
  • Speaker: Donna Dojan, MS, National Director, Contracting Policy, Standards and Compliance, Cigna
• Insurance 101: Assistance for Innovative Projects to Improve Reimbursement in Public Health Department Clinics [.zip 24.6 MB - playtime 1:55:17] April 13, 2010
  Warning: Extremely large file so provided as "zipped" file for your convenience. Opens as a Windows Media Player file (.wmv)
  • Insurance 101: Understanding Health Plan Reimbursement Policies for Immunization Services
    Speaker: Carmella Bocchino - America's Health Insurance Plans
  • CMS Medicare Provider Enrollment
    Speaker: James Bossenmeyer - Centers for Medicare and Medicaid Services (CMS)
  • Insurance 101: What Providers Need to Know About the Submission and Reimbursement of Medicare Influenza and Pneumococcal Claims
    Speakers: Leslie Trazzi and Bridgitte Davis – CMS
  • Presentation from Deschutes County Health Department (Oregon)
    Speakers: Heather Kaisner and Kacy Burgess – Deschutes County (Oregon) Health Department
• 1st day - Planning and Implementation Webinar [.wmv 20 MB - playtime 1:25:36] September 28, 2011
  • Medicare Enrollment Requirements
    Speaker: Eileen Turner - CMS, Provider Enrollment Operations Group
  • Insurance 101: What Providers Need to Know About the Submission and Reimbursement of Medicare Influenza and Pneumococcal Claims
    Speakers: Bridgitte Davis and Jocelyn Lissone - CMS
  • Medicaid Coverage and Reimbursement of Vaccines and Vaccine Administration
    Speaker: Gerald Zelinger - CMS
  • Insurance 101: Understanding Health Plan Reimbursement Policies for Immunization Services
    Speaker: Wayne Rawlins, MD - America's Health Insurance Plans
  • Arkansas and Oklahoma Department of Health: Hints and Tips on Implementation
    Arkansas Speakers: Lee Clark and Michelle Snortland
    Oklahoma Speaker: Yvonne Myers
• 2nd day - Planning and Implementation Webinar [.wmv 12 MB - playtime 56:32] September 29, 2011
  • Medicare Enrollment Requirements
    Speaker: Eileen Turner - CMS, Provider Enrollment Operations Group
  • Medicare Claims
    Speakers: Bridgitte Davis and Jocelyn Lissone, CMS
  • Medicaid Claims
    Speaker: Gerald Zelinger, CMS
  • AHIP Introduction
    Speaker: Dr. Wayne Rawlins, America’s Health Insurance Plans

Presentations Given By CDC Staff

• Billing Program Final Plans from Billing Stakeholder Meeting  [322KB - 27 slides] February 1, 2012
  Presenter: Capt. Duane Kilgus, RS, MPH
• Billing Partner Update: Innovative Projects to Improve Reimbursements in Public Health Department Clinics [383KB - 17 slides] November 14, 2011
  Presenter: Capt. Duane Kilgus, RS, MPH
• An Immunization Safety Net Without Missed Opportunities: Status of the Public Sector Billing Project National Vaccine Advisory Committee [1.02MB - 26 slides] September 14, 2011
  Presenter: Lance E Rodewald, MD
  

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