Oftentimes, healthcare consumers do not consider the cost of care unless it’s part of a bill for service. Healthcare providers, on the other hand, have dedicated departments to ensure that coding and billing is done quickly, accurately and for good reason. In a recent study, the Healthcare Financial Management Association (HFMA) reports that COVID-19 continues to negatively impact hospital finances. Many reported recently that non-COVID and elective procedures are still down, yet costs remain high. Additionally, the Medicare fee-for-service payment might not always cover the cost of COVID-19 treatment.
In the bigger picture, then, a $40 reimbursement hardly sounds like much. But when healthcare providers are not collecting the right information on patients who get the COVID-19 vaccine, they could be leaving millions of dollars on the table.
Lost Cash Opportunity
Valerie Barckhoff, Principal and Leader of Windham Brannon’s Healthcare Advisory practice, recently performed an informal inquiry into how Atlanta healthcare providers are handling COVID-19 vaccine administration. She, like many other Americans, was not asked to provide her insurance card when she got the vaccine. Even though healthcare providers cannot charge patients for the vaccine and vaccine administration does not require insurance, providers are not registering patients or requesting insurance information. In short, they are limiting themselves for reimbursement for administration, a lost cash opportunity at a time when cash is sorely needed.
Reimbursement Rates for COVID-19 Vaccines
Starting March 15, 2021, the Centers for Medicare and Medicaid Services (CMS) raised the reimbursement rates for COVID-19 vaccines. Reimbursement rates are as follows.
Starting March 15, 2021:
- $40 for each dose of the vaccine
Prior to March 15, 2021:
- $28.39 for single-dose or final vaccines in a series
- $16.94 for first doses in a series of two or more doses
Rates, both pre-and post-March 15 are geographically adjusted.
Two-thirds of the Atlanta healthcare providers that Valerie spoke with recently are not registering patients or collecting insurance information. Across 100,000 doses, that is $4,000,000 in cash that cannot be recovered once the vaccine is administered. A large healthcare provider administering hundreds of thousands of vaccine doses throughout the pandemic that is not collecting insurance information or registering patients could be losing out on millions of dollars.
Healthcare providers deserve to get paid. The drug itself may be free, but the staff salaries to prepare and administer the vaccine are not.
Why are Healthcare Providers Not Taking Steps to get Reimbursed for the Vaccine?
Part of the issue could be confusion about the rules. While patients cannot be billed, the government and private insurers can. In general, for the COVID-19 vaccine, providers can bill for only the vaccine administration, and exclude the vaccine codes on the claim. Vaccines can be submitted on single claims or a roster bill for multiple patients at a time. Healthcare providers that participate in a Medicare Advantage Plan can submit COVID-19 claims to Original Medicare for all patients who are enrolled in Medicare Advantage in 2020 and 2021.
CMS has more information here on how to bill for the COVID-19 vaccine.
Another reason providers may not be not asking for insurance or registering patients, is how the public could perceive that action. As Valerie said, “we can script that.”
She concluded that a logical explanation is a fear that a bill will slip through the cracks and make it to a patient, which has happened recently. But she also said that “Everyone has edits! We need to use them. Edits and controls should be in place to prevent these claims from going out the door.”
Solutions to Improve Billing Process
If a provider is concerned that patient registration could delay providing the vaccine, processes can be changed. For example, copy and scan the driver’s license or state ID and enter the information later.
Regardless of the reason for not doing it, healthcare providers need to start billing and getting reimbursed for administering the COVID-19 vaccine. More people are eligible for the vaccine, second doses are scheduled and boosters are a real possibility. Set up the codes to bill. Review processes for each location where the shot is administered and design those processes with the patient in the middle. Develop scripts for the patients, staff and public. Collect those reimbursement fees!
When your healthcare organization receives the funds, treat the revenue from the reimbursements like commercial reimbursements.
When considering how to allocate the reimbursements with this unexpected revenue, one option is to provide bonuses to the healthcare workers.
Vaccine administration may be one way your organization is leaving money on the table. There may be other sources of revenue leakage in your billing processes. Windham Brannon’s Healthcare Advisory team can help your organization discover inefficiencies and remediate processes to increase revenue.
Windham Brannon’s Healthcare Advisory team is committed to helping healthcare providers increase revenue and properly bill for COVID-19 vaccines.
Email Windham Brannon’s Healthcare Advisor Valerie Barckhoff for a consultation to discuss your COVID-19 vaccine administration plan.