Public health services have traditionally been viewed as free, and a move toward billing for these services requires a paradigm shift for both Local Health Department (LHD) staff and individuals seeking services. For LHDs, billing is a comprehensive approach and not isolated to just one clinical service. Most LHDs establish billing programs to include all of the clinical services that they provide. Once a health department has established a billing infrastructure, it can seek revenue across programs for reimbursable services such as immunizations.
Ultimately, state or local health departments should decide to bill after carefully assessing the communities they serve. For example, LHDs within the states that have declined Medicaid expansion and that serve predominately uninsured communities may not find revenue generation feasible. If billing is the right decision for the LHD, dwindling public funds could be used for the most vulnerable populations.
Although a majority of health departments have a long history of working with public insurance providers (e.g., Medicaid, Medicare, Children’s Health Insurance Program), many have found the transition to working with private insurers difficult. Despite challenges, LHDs have remained persistent and have developed creative ways to establish successful billing programs.
Billing for immunization of insured individuals makes sense as a way to save money for federal, state, and local governments, assure proper stewardship of public funds and promote public and private payer participation. LHDs play an important role in achieving immunization objectives. The costs of immunizing children and adults can place a burden on the scarce resources of public health departments, unless a proper billing program is in place.
Many of the children and adults seen by LHDs either already have insurance or are potentially eligible for insurance coverage for immunization services. Public programs including Medicaid, Family Health Plus (FHP) and Child Health Plus (CHP), as well as Vaccines For Children (VFC), fund immunizations for individuals with limited financial means. The 2010 Patient Protection and Affordable Care Act (PPACA) is expected to further increase the proportion of the population with insurance coverage for immunizations by increasing the number of insured individuals and requiring coverage of preventive services, including immunization, for both adults and children.
Finally, there are a number of laws and program requirements that require LHDs to bill for services. LHDs provide services and receive funding through public programs. Compliance with the various program requirements, requires LHDs to bill as appropriate. There are many factors that determine the ability of LHDs to bill for immunizations services: local delivery and billing practices for a range of public health services, immunization service volume, and the public and commercial insurance markets.
This paper provides an overview for Illinois public health immunization billing including billing Medicare, Medicaid, and private insurance; but these activities do not exist in isolation. They fit into a bigger picture of planning, budget and policy development, organizational objectives, grants, programs, and community priorities. Billing allows health departments to identify and tap into existing sources of revenue to survive, even thrive, through tough economic times when people often need care most.