Establishing a strategic plan for West Virginia local health departments to enhance billing systems for reimbursement of immunization services

Background. Immunization billing is critical to sustaining the delivery of clinical services by local health departments. Operating in today’s health care environment requires health departments   to maximize their reimbursement potential for services rendered to ensure long term financial viability and preservation of the critical public health resources they provide. Objective. To establish an evidence base to understand current capacity, needs, readiness, barriers, and regulations related to billing by health departments in West Virginia.  To use the evidence base to develop a strategic plan, training, and approaches to strengthen stakeholder relationships needed to support successful billing program implementation. Design. In 2013, an evaluation was conducted to study billing capabilities, capacity, collections, expertise/readiness, review of laws, regulations, and perceptions of key stakeholder.  Using the data collected, with facilitated guidance from state and local public health administrators, the West Virginia Immunization Billables Strategic Plan was developed. Results. A 90% survey response rate indicated 78% agencies billing, 62% interested in billing expansion, 75% with unique barriers, and broad diversity in perceived readiness and expertise. Following a review of findings and SWOT analysis, five goals were established, including Board communication, training and technical assistance, the need for performance management, best practices, and stakeholder development. Conclusions.  For health departments seeking to continue the provision of immunizations and other clinical services, effective strategies for the implementation and/or enhancement of billing programs is a priority. Development of The West Virginia Immunization Billables Strategic Plan provides a systematic, evidence-based approach to guide health departments in establishing such billing programs.