COVID-19 Vaccine Billing Practices
The COVID-19 Vaccination Program’s primary goal is to administer COVID-19 vaccine safely, quickly, and equitably to all populations across the state. In order to do this, it is critical that all individuals have access to free COVID-19 vaccine.
Wisconsin is at a pivotal point in the COVID-19 response, and the Wisconsin Department of Health Services (DHS) is working to address all potential barriers to vaccination, including access to free vaccine. Therefore, DHS would like to remind vaccine providers of important COVID-19 vaccine billing practices and policy.
The COVID-19 vaccine is provided to Wisconsin by the Federal Government and therefore must be administered at no cost to all recipients. By signing the CDC COVID-19 Vaccination Program Provider Agreement to receive and dispense vaccines, providers are committing to being accountable for the conditions specified in the agreement. View the agreement here.
In addition to the terms specified in the Provider Agreement, all organizations and providers participating in the CDC COVID-19 Vaccination Program are expected to adhere to the following CDC guidelines:
- Must administer COVID-19 vaccine at no out-of-pocket cost to the recipient.
- May not deny anyone vaccination based on the vaccine recipient’s coverage status or network status.
- May not charge an office visit or other fee if COVID-19 vaccination is the sole medical service provided.
- May not require additional medical services to receive COVID-19 vaccination.
- May seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the vaccine recipient, such as:
- Vaccine recipient’s private insurance company
- Medicare or Medicaid reimbursement
- HRSA COVID-19 Uninsured Program for non-insured vaccine recipients
- May not seek any reimbursement, including through balance billing, from the vaccine recipient.
DHS is collaborating with our federal and state partners to closely monitor provider program compliance and billing practices. This includes investigating all instances of inappropriate billing and fraud reported by Wisconsinites, conducting analyses of COVID-19 vaccine administration data, and initiating CDC-required on-site visits.
How to Report Inappropriate Billing Practices and Denied Access to COVID-19 Vaccine to the State of Wisconsin:
The public can also report fraud, waste, and abuse of all other public funds to DHS through the fraud hotline at 877-865-3432 or through the fraud reporting website.
Vaccinator and Stakeholder Resources
|
