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 $27.5 million to 38 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

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 Organization of County and City Health Officials (NACCHO) is developing a tool kit to assist awardees with billing practices.

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 April 2013:

• 38 awardees have received funding for planning, implementation, or both
• 13 of the 14 ARRA awardees funded in 2009 have provided implementation plans. Oklahoma has a no-cost extension still in effect
• 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
  • Many are able to bill Medicare and Medicaid specifically for flu vaccine. Efforts are being made to collect more specific data
  • 13 of the 14 implementation awardees will seek no-cost extensions to complete their projects in an orderly manner
• NACCHO was funded in 2011 to work on a billing tool kit to be available online
  • The first parts of the tool kit were up and running as of August 2012
• 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 underway. Testing of evaluation questions and data collected is expected by next month. We hope to see the preliminary results of evaluation available by mid-summer
• We are currently working on a stakeholder meeting to take place in August 2013. Participants will include payers, awardees, and partner organizations

Billing Resources

• National Association of County and City Health Officials (NACCHO) Billing Toolkit
  NOTE: You will need to log into your NACCHO account or register for a new account before you can access the billing toolkit.
• California's Immunization Billing Project Plan [5.33 MB, 96 pages]
• Kansas Foundation for Medical Care Immunization Billing Stakeholder Group
• Georgia Department of Public Health Publications
• The Washington State Local Health Jurisdiction Immunization Billing Resource Guide [5.54 MB, 192 pages]

Association of Immunization Managers Meeting, November 2012

• Billing Systems Program Perspective:  Oklahoma  [324 KB, 24 pages]
  Speaker:  Yvonne Myers, Oklahoma State Department of Health

• Billing Systems Program Perspective:  California  [893 KB, 36 pages]
  Speaker:  Denise Smith, Kern County Public Health Services

• Billing Resources and Toolkit:  NACCHO  [610 KB, 10 pages]
  Speaker:  Rebecca Gehring, National Association of County and City Health Officials

Webinars

• Other Issues in Establishing a Vaccine Billing Infrastructure [.zip 12 MB, playtime 59:47] September 25, 2012
  Warning: Extremely large file so provided as "zipped" file for your convenience. Opens as a Windows Media Player file (.wmv)
  • Speaker: Wayne Rawlins, MD, MBA, National Medical Director, Racial and Ethnic Equality Initiatives, Aetna
• 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 – Centers for Medicare and Medicaid Services (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 - Centers for Medicare and Medicaid Services (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 - Centers for Medicare and Medicaid Services (CMS)
  • Medicaid Coverage and Reimbursement of Vaccines and Vaccine Administration
    Speaker: Gerald Zelinger - Centers for Medicare and Medicaid Services (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 - Centers for Medicare and Medicaid Services (CMS), Provider Enrollment Operations Group
  • Medicare Claims
    Speakers: Bridgitte Davis and Jocelyn Lissone - Centers for Medicare and Medicaid Services (CMS)
  • Medicaid Claims
    Speaker: Gerald Zelinger - Centers for Medicare and Medicaid Services (CMS)
  • AHIP Introduction
    Speaker: Wayne Rawlins, MD - America’s Health Insurance Plans

Presentations Given By CDC Staff

• Billing Program Final Plans from Billing Stakeholder Meeting  [322 KB, 27 slides] February 1, 2012
  Presenter: Capt. Duane Kilgus, RS, MPH
• Billing Partner Update: Innovative Projects to Improve Reimbursements in Public Health Department Clinics [383 KB, 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 [1.02 MB, 26 slides] September 14, 2011
  Presenter: Lance E Rodewald, MD
  

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