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Developing Mechanisms for Billing

Innovative Projects to Improve Reimbursement for Immunization Services Provided by Public Health Department Clinics

CDC’s billing program has been supported through the federally legislated American Recovery and Reinvestment Act of 2009 (ARRA) and the Affordable Care Act Prevention and Public Health Fund (PPHF), as well as 317 funds.  Since 2009, it has enabled project awardees to develop plans that will enable them to bill for vaccine services.  Each billing program awardee organization develops a public health action plan describing activities, protocols, and procedures needed to pilot, initiate, and sustain a successful billing effort within the immunization program.

Status as of December 2015:

  • 38 awardees have received funding for planning, implementation, or both.
  • Implementation awardees supported to develop billing systems are currently at various stages of billing:
    • All are working on or have already developed contracts with payers.
    • All are conducting assessment and training on billing with local health departments.
    • 32 awardees are able to bill Medicaid and 31 are able to bill Medicare specifically for flu vaccine.
  • An article describing CDC’s Billables Project was published in the July/August 2014 issue of the Journal of Health Management and Practice [1].
  • At least six states which have participated in the billing program have also seen legislation pass to support the ability of local health departments and clinics to bill for immunization services.
  • In 2011, the National Association of County and City Health Officials (NACCHO) developed a Billing Toolkit, which is available online and has been consistently updated to include materials developed by billing program awardees (see Billing Resources).
  • In August 2012, CDC conducted a three-part series of training on billing concepts in conjunction with America’s Health Insurance Plans (AHIP) (see Billing Resources).
  • In 2013, stakeholder meetings were held in Washington, DC, and Atlanta, Georgia, to allow payers, awardees, and partner organizations to share knowledge and resources. Those meetings facilitated contracting opportunities between some awardees and payers.

The majority of immunization grantees that have conducted planning and implementation of billing programs have shown the capacity to bill for immunization services. However, they continue to face barriers to full implementation, which means billing all payers for all vaccine and administration costs for all patients in health departments across their jurisdictions.


Footnote

  1. Kilgus CD, Redmon GS. Enabling reimbursement to health departments for immunization services. J Public Health Manag Pract. 2014;20(4):453-5. Doi:10.1097/PHH.0b013e3182a9dc03.

CDC Billing Program Awardees, 2009-2014. Map shows states with implementation only (Massachusetts, North Dakota, and Oregon); states and cities with planning only (Alabama, Connecticut, Delaware, District of Columbia, Indiana, Louisiana, Maryland, Minnesota, Nebraska, South Carolina, Texas, Wisconsin, Wyoming, Houston and New York City); and states and cities with planning and implementation (Arizona, Arkansas, California, Colorado, Georgia, Illinois, Iowa, Kansas, Michigan, Mississippi, Missouri, Montana, Nevada, New Mexico, New York, Ohio, Oklahoma, Tennessee, Virginia, Washington, West Virginia, and Chicago).

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