Adding up the Benefits of Billing for Influenza Vaccinations Adminitered In School-Located Clinics. Experiences From Two Oregon Counties

Background:  Oregon’s Local Health Departments (LHD) have been coordinating  with schools to provide influenza vaccination in school-located clinics at no cost to schools and parents since 2006. In 2010, after a 3-yr pilot to assist LHDs in developing partnerships, the Oregon Immunization Program ceased providing LHDs influenza vaccine at no cost for school-located clinics.  In an effort to develop more sustainable approaches for vaccine delivery to school-aged children, two counties piloted a project in the 2010-2011 influenza season to bill for influenza vaccine and/or vaccine administration in school clinics.  

Setting:  Two elementary schools in Marion County and 1 elementary-middle school, 1 high school and 1 charter school (grades 4-12) in Yamhill County (Sheridan school district).

Population:  Approximately 440 children between 5 and 17 yrs of age in participating schools in Yamhill and Marion counties of Oregon.

Project Description:  Evaluation of the resources utilized and the effectiveness of the billing process for school-located clinics. Evaluation measures include the amount of time staff spent capturing and tracking the billing process, and  outcomes achieved, including;  the number of claims submitted, the number of claims denied, the number resubmitted, the number with changed codes (billable to VFC), and the number of  claims reimbursed from each of the clinics. An additional measure includes the number/percent of uninsured students who paid the requested administration fees for VFC vaccine.

Results/Lessons Learned:  Preliminary data show that 63% of students vaccinated in Marion County and 78% vaccinated in Yamhill County were covered under either Medicaid or private insurance. 5% of individuals (n=5) who did not provide billing information either paid the $15 administration fee or applied for a reduced fee in Marion County, compared to 100% (n=36) in Yamhill.  The billing process is occurring now, so final tallies for time spent and billing outcomes are pending.