Member Spotlight

Commonwealth Medicine: Vaccine Reimbursement Program

Building systems for vaccine billing

The Vaccine Reimbursement Program at UMass Medical School Commonwealth Medicine allows local public clinic immunization providers to claim for immunization services rendered in their communities.  By leveraging economies of scale for local public providers, the Vaccine Reimbursement Program is able to offer a centralized mechanism for contracting and claiming for vaccine services with third party payors.

Currently, the Vaccine Reimbursement Program:

  • Serves local public providers – Health Departments, Boards of Health, VNAs, Public Schools, and other community-based organizations enrolled in the MDPH Immunization Program.
  • Bills over 73,000 patient immunizations each season with over 85,000 Massachusetts residents immunized each year.
  • Contracts with 157 public providers in Massachusetts that represent over 240 municipalities and serves 25 school districts in Maine.

Created in Response to the H1N1 Influenza Pandemic

Frequently under-staffed and under-funded, local boards of health are often unable to operate or staff billing departments for health care services.  The H1N1 influenza pandemic in 2009 placed an added financial burden on local public providers throughout Massachusetts. Local boards of health were responsible for conducting H1N1 and seasonal influenza vaccination clinics for large numbers of children and families without a mechanism for reimbursement. Additionally, health plans did not historically cover the cost of administering the influenza vaccine outside of the primary care setting.

To relieve the financial strain on the municipalities vaccinating patients during the pandemic, Commonwealth Medicine partnered with the Massachusetts Department of Public Health to increase access to vaccines in public clinics while providing financial support to public providers.

Commonwealth Medicine Vaccine Program Expansion and Evolution

Services Offered

The Vaccine Reimbursement Program aims to remove barriers and increase access to immunization services. Offering a centralized mechanism for claiming not only saves money and time for local public providers, but allows them access to contracts with commercial payors that may not otherwise be available to these provider types.

Since the program’s creation, the Vaccine Reimbursement Program has doubled the amount of health plans that participate from six to 12. The program has also expanded to include reimbursement beyond seasonal influenza vaccines to include all child and adult vaccinations routinely recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP).  With a 93% reimbursement rate, the Vaccine Reimbursement Program has generated over $12M in revenue back to local public providers since its inception.

Looking toward the future

The Vaccine Reimbursement Program admires the work and efforts of their clients and are happy the program helps support their immunization goals. Local public health nurses work diligently to address the public health needs of their communities, and the Vaccine Reimbursement Program hopes to continue evaluating other ways to expand and improve the program to support their efforts into the future.

Click the link for more information about The Vaccine Reimbursement Program
or contact:

Brittany Rahall
Sr. Manager
Commonwealth Medicine
Brittany.rahall@umassmed.edu  

 

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