Working with Public Health Programs: Improving Vaccine Reimbursement

Background:  :  Billing and collecting for vaccines can be a daunting task.  The CDC wants public health providers to collect payment from patients who have medical/pharmacy benefit coverage.  The Affordable Healthcare Act and other federal and state regulatory bodies are pushing for improved utilization and reporting.  To meet these requirements providers need to understand the differences between pediatric and adult vaccine benefits and how they are billed.  Providers need to:

• Determine patient eligibility
• Have access to a medical billing system for vaccines covered by medical benefits
• Have access to a pharmacy billing system for vaccines covered by pharmacy benefits
• Have coding capabilities
• Contract with third party payers
• Meet special Medicaid/County/State billing and registry reporting requirements

Setting: Public and Community Health Centers

Population: Medicare and Medicare

Project Description:  Case studies from public health centers will demonstrate how providers that had no internal billing capabilities were able to successfully overcome many of these challenges.  Studies will also include examples of how providers with medical billing capabilities were able to add adult vaccines covered by Medicare Part D pharmacy benefits.  Utilization statistics , trends and contracting tips will also be included.    

Results/Lessons Learned:  An understanding of the options available for submitting vaccines claims and how they may be able to improve existing submission processes.