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2009 H1N1 Vaccine : Financing and Billing

Learn about the financing principles for H1N1 vaccination, including billing options and coverage for different patient groups. Find useful web links for more information.

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2009 H1N1 Vaccine : Financing and Billing

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  1. 2009 H1N1 Vaccine :Financing and Billing Megan C. Lindley, MPH CDC H1N1 Vaccine Implementation Team

  2. General H1N1 Financing Principles • Vaccine and ancillary supplies are purchased and provided by the federal government, so no charge for these is permitted • Not part of the Vaccines for Children (VFC) program • Vaccine providers can charge a vaccine administration fee to the patient, or bill their health insurance plan, or other third party payer • Goal of vaccination financing: to balance reasonable payment to providers with affordable access to individuals

  3. Who Covers H1N1 Vaccination? • Medicare • Medicaid/CHIP • All eligible children • Adults in mandatory settings, including RHCs • TRICARE & CHAMPVA • In certain settings: IHS, VA, DoD • Many private health insurance plans

  4. Under- and Uninsured Patients (1) • Private sector • Providers are encouraged to vaccinate those who cannot pay; if unable, providers should refer these patients to a public health clinic or affiliated public health provider • Providers may collect an out-of-pocket charge up to the regional Medicare reimbursement rate for seasonal influenza vaccine administration

  5. Under- and Uninsured Patients (2) • Public sector • Phase 3 Public Health Emergency Response (PHER) funding for CDC grantees, to support implementation of H1N1 vaccination campaigns • 50 states, some large cities, U.S. territories • PHER grantees and those working on behalf of public health agencies are prohibited from turning away persons due to an inability to pay

  6. Billing for H1N1 Vaccine Administration • Many public and private health insurance plans are waiving cost-sharing • New CPT and HCPCS codes specific to H1N1 vaccine and H1N1 vaccine administration • All providers may bill health insurance plans or other third-party payers • Public health departments or those vaccinating on behalf of public health may not collect any out-of-pocket charges including co-pays

  7. H1N1 Financing Web Links • http://www.cdc.gov/H1N1flu/vaccination/statelocal/vaccine_financing.htm • http://www.cdc.gov/h1n1flu/vaccination/statelocal/vaccing_billing_qa.htm • http://www.flu.gov • http://www.cms.hhs.gov/H1N1/

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