Providers who have previously been left footing the bill after administering Covid-19 vaccines to patients whose insurance doesn’t cover the shot can now turn to a new reimbursement option being offered by The Department of Health and Human Services (HHS).
The newly launched Covid-19 Coverage Assistance Fund (CAF) gives providers the opportunity to request reimbursement for vaccine-related services that are not fully covered by a patient’s insurance.
Under the CARES Act and FFCRA, providers are barred from billing patients for vaccination-related fees. While the existing HSRA Uninsured Patient Portal provides reimbursement for treating uninsured individuals, there previously was no safety net to pay providers for treating insured patients whose plans did not fully cover vaccine-related services.
To address this gap, the fund will compensate providers for eligible claims at national Medicare rates. In March, CMS raised the national average payment rate for administering a single dose of a Covid-19 vaccine to $40, up from the $28 rate established last year. This move also raised the payment rate for administering vaccines that require two doses from $45 to $80.
Health care providers can request claims reimbursement, through the Covid-19 CAF electronically and will be reimbursed at the national Medicare rate for vaccine administration, and for patient charges related to Covid-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance, subject to available funding.
Before submitting a claim to the Covid-19 CAF, the provider must submit a claim for vaccine administration to the individual’s health plan for payment and have the claim denied or only partially paid. Providers are not required to ascertain a patient’s immigration status in order to receive reimbursement from the fund.
Money to pay providers is being drawn from the HHS Provider Relief Fund. The CAF program will accept eligible claims from providers dated on or after December 14, 2020.