To be eligible for reimbursement from the new fund, a provider must have first submitted the claim to a health plan and had the claim denied or only partially paid.
The Health Resources and Services Administration (HRSA) announced a new program to reimburse healthcare providers for administering COVID-19 vaccines to patients whose health plans either do not cover vaccination fees or require cost-sharing.
The HRSA statement notes that because providers are prohibited from billing patients for vaccination fees, the COVID-19 Coverage Assistance Fund (CAF) has been instituted to address “an outstanding compensation need for providers on the front lines vaccinating underinsured patients.”
Payment will be made at Medicare rates, which previously were bumped up to $40 for single-dose vaccines and $80 for two doses.
Even though the government has funded the full cost of vaccines, providers incur costs in areas such as training, staffing and storage, HRSA noted in a news release. Federal guidelines prohibit billing patients for vaccine administration.
Providers may seek reimbursement from a patient’s health plan, but the plan may deny payment or withhold the patient’s cost-sharing amount.
Going forward, “providers should submit their COVID-19 vaccine administration fee claims for reimbursement consideration to the CAF. To be eligible for reimbursement, the provider must have first submitted the claim to the individual’s health plan for payment and had the claim denied or only partially paid,” according to the news release.
HRSA notes that claims must be submitted electronically and are subject to available funding, which is sourced from the Provider Relief Fund.
In a statement, Xavier Becerra, secretary of the U.S. Department of Health and Human Services, said the fund closes “the final payment gap that resulted as vaccines were distributed to underinsured individuals.”
Providers who administer the vaccine to uninsured individuals have been eligible to submit claims to the HRSA COVID-19 Uninsured Program.
Explanatory webcasts on the CAF will take place May 6 and May 12.