New HHS Reimbursement Program Requires Scrutiny of COVID-19 Vaccination Claims

On May 3, 2021, the U.S. Dept. of Health and Human Services announced a program to cover costs of administering COVID-19 vaccines to patients whose health plans either do not cover vaccination fees or cover them with patient cost-sharing, effective with date of service December 14, 2020. As providers are not permitted to bill patients for such fees, this new program, the COVID-19 Coverage Assistance Fund (CAF) bridges a crucial gap in compensation for providers vaccinating underinsured patients. More information about the program is available here

According to guidance issued by the Centers for Disease Control and Prevention in February, all organizations administering COVID-19 vaccines must do so regardless of the recipient’s coverage status at no out-of-pocket cost to the recipient. 

Because this fund was created to assist providers in recovering dollars for the patient’s cost-sharing portion of their vaccine administration fees, the most straightforward strategy for handling applicable claims is by an exception-based model. Automation can help provider organizations identify such exceptions and ensure claims are coded appropriately.

By Mario DiPisa,
Director, Operational Performance Management
Ensemble Health Partners

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