Developing Mechanisms for Billing

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

CDC’s billing program was supported by 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. Starting in 2009, the program enabled project awardees to develop plans that would enable them to bill for vaccination services. Each billing program awardee organization developed a public health action plan describing activities, protocols, and procedures needed to pilot, initiate, and sustain a successful billing effort within its immunization program.

  • 38 awardees received funding for planning, implementation, or both.
    • Most awardees demonstrated the ability to contract with both public and private payers.
    • 32 awardees were able to bill Medicaid and 31 were able to bill Medicare specifically for flu vaccine.
  • An article about barriers facing health departments in establishing billing programs and possible solutions was published in the May/June 2018 issue of the Journal of Public Health Management and Practice[2].
  • An article describing Billables Project was published in the July/August 2014 issue of the Journal of Public Health Management and Practice [1].
  • 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.
  • 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).
  • At least six states that participated in the billing program also saw 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 Toolbox, which has been available online and consistently updated to include materials developed by billing program awardees (see Billing Resources).

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


Footnotes

  1. Kilgus DK, 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.
  2. Corriero R, Redmon, GS. Planning and implementing immunization billing programs in state and local health departments: barriers and possible solutions. J Public Health Manag Pract. 2018;24(3):248–254. Doi:10.1097/PHH.0000000000000676.
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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Page last reviewed: November 15, 2019