Developing Mechanisms for Billing
Innovative Projects to Improve Reimbursement for Immunization Services in Public Health Department Clinics
CDC, through the federally legislated American Recovery and Reinvestment Act of 2009 (ARRA), began providing more than $6.5 million in 2009 to 14 program awardees 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 provided more than $13 million in 2011 to 14 additional program awardees to develop plans that will enable them to begin billing for vaccine services. Half of the original 14 awardees have moved to the next step of implementing their plans, and the National Association of County and City Health Officials (NACCHO) has developed a tool kit to assist awardees with billing practices (see Billing Resources).
Through the federally legislated Affordable Care Act, Prevention and Public Health Fund (PPHF), CDC provided more than $8 million in 2012 to seven additional program awardees to develop plans that will enable them to begin billing for vaccine services and seven more awardees to pursue full implementation of billing across their jurisdiction.
Awardees 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.
Status as of November 2013:
- 38 awardees have received funding for planning, implementation, or both
- All 14 ARRA awardees funded in 2009 have provided implementation plans
- All 14 of the PPHF awardees funded in 2011 for planning have made great strides in their plan development, and will be evaluating and piloting their project plans over the next several months
- Implementation awardees funded in 2011 and 2012 are at various stages of billing
- All are working on or have already developed contracts with payers
- All are conducting assessment and training with local health departments on billing
- Most are able to bill Medicare and Medicaid specifically for flu vaccine. Efforts are being made to collect more specific data
- NACCHO was funded in 2011 to work on a billing tool kit that is now available online
- In August 2012 CDC conducted a three-part series of training in conjunction with America’s Health Insurance Plans (AHIP) on billing concepts
- Evaluation activities are complete, and results are being presented in internal and external meetings and being prepared for publication
- A stakeholder meeting was held in August 2013 and was attended by payers, awardees, and partner organizations. Participants shared billing knowledge and resources, and some awardees reported that they were able to secure contracts as a result of interaction at the meeting
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