Health Insurance, healthcare reimbursement, hospital cost, Providers Receive Fund

Providers Receive Fund from HHS for Underinsured Vaccine Administration

VACCINE & THE FINANCIAL TROUBLE

Since the COVID-19 vaccination started in the country, more than 247 million doses have been administered. More than 105 million people (around 31.8 percent of the total population) have received both doses – as per the data provided by the Centers for Disease Control and Prevention (CDC). However, the number of daily doses administered has decreased from March – from 3 million shots per day to currently around 2.45 million doses per day.

The country is reaching the point where supply is more than the demand as few parts of the population remain hesitant regarding the vaccine, and some others are hard to reach. Several states are shifting the vaccination program to more local sites like pharmacies and physician practices, to cope up with the problem.

More and more primary care practices are administering vaccines than before, despite facing pandemic strains and financial struggle.

WAY OUT OF THE PROBLEM

Health and Human Services (HHS) have initiated a new program (Provider Relief Fund) that will reimburse the providers who are administering vaccines to patients with health plans which do not cover such services. The program will be of great help not only for the providers but also for the underinsured patients.

The COVID-19 Coverage Assistance Fund (CAF) was brought into effect last week through the Health Resources and Services Administration (HRSA). The purpose of this fund is to cover the costs for administration of the vaccine for providers who are treating patients covered under health plans that either covers vaccination fees with patient cost-sharing or do not cover them.

The program(Provider Relief Fund) was developed by HHS to help providers close the reimbursement gap. The providers, by federal law, are forbidden from charging or balance the billing patients for COVID-19 vaccination. HHS had to remind the providers about this regulation last month after multiple reports were received where patients were charged by the providers for the administration of vaccines.

The HHS Secretary announced that healthcare providers should not hesitate before delivering such critical vaccines to the patients over any concerns regarding reimbursement costs. The providers will be reimbursed at the fixed national Medicare rates for the administration of vaccines. Medicare currently reimburses providers $40 for a single-dose vaccine and $80 for a double-dose.

The rates were increased in March by HHS from $28 for the administration of a single-dose vaccine and $45 for a double-dose to boost the access of vaccines to providers, and eventually, to people.

WHAT THE CAF COVERS…

The reimbursement will be provided from the Provider Relief Fund, which was established by the CARES Act, and will be receiving all eligible claims from the providers dated on or after December 14, 2020. HHS also clarified that the claims need to be submitted electronically, and are subject to available funding. In addition to that, the claims will be eligible for reimbursement only after they have been denied or have been paid partially by the patient’s health plan.

The reimbursement process covers the vaccination fee and patient charges that include deductibles, co-payments, and co-insurance for the administration of vaccines.