VFC Screening Presentation for LHJ use

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Vaccines for Children (VFC) Status
ScreeningPlanning for Washington State
Insert LHJ logo here
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Goals for Today

• Overview of VFC Status Screening
• Review and discuss
• Provider effort and benefit
• Screening tools paper, electronic, CHILD Profile
• Reference and education materials
• Monitoring Requirements
• Provider Profiles / Benchmarking

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Washington StatesChildhood Vaccine Program

• A universal childhood vaccine program
• Vaccines purchased by state using combination of
  state and federal funds.
• All children birth up to their 19th birthday can
  receive childhood vaccine at no cost
  regardless of VFC status.
• A large percentage of vaccine comes through the
  federal Vaccines for Children (VFC) Program.
• VFC program is an entitlement.
• A childs VFC status is based on insurance and
  specific demographics.
• The CDC requires that every child be screened for
  their VFC status at every visit.

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What is VFC Status Screening?

• VFC Status Screening consists of asking and
  documenting at every immunization visit,
• The childs insurance status
• whether or not a child is enrolled in Medicaid,
• uninsured, or
• underinsured.
• The childs demographics as related to the VFC
  Program
• American Indian or Alaska Native.
• The child, parent, or legal guardian may
• be asked the screening questions or fill out a
  form.
• The screening information must be
• Captured in the childs paper or electronic
  chart.
• Kept according to the organizations record
  retention policy
• or 6 years whichever is longer.
• Reviewed by local health department during any QA
  site visit.

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Provider Effort

• Provider offices currently ask and document the
  insurance status of each child
• Usually part of the intake process
• Always part of the billing process
• Providers will need to ask and document the
  childs demographics
• American Indian or Alaska Native
• Providers may select options that fit with their
  business practice
• Providers must document VFC screening in the
  child record (or CHILD Profile Immunization
  Registry)
• Providers do not have to verify the information

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Provider Benefit

• For children with insurance through private
  health plans
• Any commercial/private health insurance
  (including SCHIP)
• Providers may bill private health plans
• The maximum allowable rate for vaccine
  administration and fee the plan will pay
• Varies by health plan
• May be 25.00 or more
• The administration fee is not limited to the
  15.60 Medicaid cap.

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Examples of Practice Benefit

• 233 vaccinations given
• 3634.80 if billed at 15.60 (CMS Cap)
• Private Health Plan Maximum Allowable
• 4488.00 administration fee
• 3645.72 vaccine storage and handling fee
• 8,133.72 Total maximum allowed
• 4,498.92 increased revenue for practice

• 100 vaccinations given
• 2,800.00 private health plan maximum
• 1,560.00 if billed at 15.60 (CMS Cap)
• 1,240.00 increased revenue for practice

example based on reimbursement from two
different health plans. May vary by plan and
patient mix.
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Provider Benefit (cont.)

• Replaces benchmarking process
• Providers will complete an annual survey instead
  of conducting a month long process for every
  patient
• Allows Washington to meet the federal screening
  requirement
• Preserves the federal portion of the childhood
  vaccine program
• Over 70,000,000 contributed each year
• Allows Washington providers to receive vaccines
  at no cost

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Billing for VFC patient

• Medicaid eligible/enrolled patients
• Medicaid for reimbursement of administration fee
  of 5.96.
• Underinsured, or Uninsured
• Maximum administration fee of 15.60
• American Indian / Alaska Native,
• Underinsured, or Uninsured
• bill patient administration fee of 15.60.
• Insured
• Bill the health insurance plan the allowable
  amount
• NOTE Vaccines must be provided even if
  patient is unable to pay fees.

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Document VFC status at every immunization visit
Using Paper Based Record

• Documentation may be incorporated into
• Patient face sheet
• Medical history sheets
• Master billing forms
• VFC screening form supplied by Department of
  Health
• The Vaccine Administration Record (VAR) supplied
  by Department of Health

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Using label on existing form
Print labels on standard label stock using
Department of Health supplied template, apply
label to existing patient intake or screening
forms, and record appropriate VFC status.
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Modify an existing intake form
Required for State-Supplied Vaccine VFC Status
Screening (check one) __Private Health Plan
Insurance __Medicaid __Uninsured (Bill VFC Max
Only) __Underinsured (Bill VFC Max Only)
Patient AI/AN demographic information already
captured on existing form
Insert text to capture insurance status
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Modify an existing master billing form
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Optional DOH Screening Form to document VFC
status at patient check in
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Vaccine Administration Record to document VFC
status at time of vaccine administration
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Using an Electronic Record

• CHILD Profile Immunization Registry

Select VFC status from dropdown list on patient
demographics screen.
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Using an Electronic Record

• Office based information systems
• electronic medical record
• electronic billing record
• a separate database
• The electronic record must be approved by the LHJ
• Consider
• Adding a field to capture VFC Status
• Using an existing field
• Identifying where in the EMR or billing system
  the data may currently be captured

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Support Documentation Provider Brochure
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Support MaterialsReception Area Flyer
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Monitoring Provider Prep for the Site Visit

• To prepare for the visit by the LHJ
• Providers should
• Be prepared to explain the screening method used
• Have 10 random charts ready for the LHJ to review
• for children less than 19 years of age
• who have had a visit since the 2009 provider
  agreement was signed (or the date the provider
  began screening).
• If an AFIX chart pull is being done
• 10 of the charts used for the AFIX may be used if
  available
• If less than 8 of 10 charts show appropriate
  screening
• The LHJ will provide technical assistance at that
  time

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Key Points to Remember

• Most of the questions are already being asked.
• Federal requirement.
• Ask every child at every immunization visit.
• VFC status Medicaid? Insurance? AI/AN?
• Document status if changed and retain record.
• Screening at every visit allows increase in
  vaccine administration fees for patients with
  commercial/private health insurance.
• Start screening (and billing) as soon as desired.
• Must start screening with 2009 VFC Provider
  Agreement.

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VFC Status screening materials and resources
available for download from the DOH Immunization
Program CHILD Profile website DOH Home CFH
Main OMCH Main Immunization Program
Vaccines  Vaccine Supply (http//www.doh.wa.gov/
cfh/Immunize/vaccine/vaccine-supply.htm)
LHJ contact information for VFC status screening
insert LHJ contact information
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