Billing Office Tips for MnVFC
Minnesota Vaccines for Children Program
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Tip #1: Please be prepared to respond to questions about MnVFC eligibility.
Tip #2: Charge only allowable fees for MnVFC.
Tip #3: Be prepared to remove vaccine charges from a MnVFC-eligible patient's bill.
Tip #4: Waive the administration fee if a patient is unable to pay it.
Tip #5: Make sure you enter the correct CPT code for each vaccine.
Tip #6: Call the MnVFC program if you have complex billing issues.
The Minnesota Vaccines for Children (MnVFC) program provides vaccine for MnVFC-eligible children at clinics enrolled in the program. Your clinic billing office may get calls from patients who have questions about MnVFC or who request that you adjust their bill for vaccination(s) because they are eligible for MnVFC. Here are some tips for handling those situations.
Your clinic screens patients to find out if they are eligible for MnVFC before giving them immunizations and keeps that screening information on file. For up-to-date details on eligibility, see the MnVFC Patient Eligibility Screening Record forms.
The MnVFC program has a self-screening form for children that parents can fill out called Can my child get free or low-cost shots? You might find it a useful reference as well.
There are three costs associated with each immunization, the cost of:
- the vaccine,
- administering the vaccine, and
- the office visit.
MnVFC covers the cost of vaccines by providing vaccine to clinics. Since this vaccine is provided to your clinic at no charge, you cannot charge the patient for the cost of this vaccine. In addition, the program caps the administration fee you may charge MnVFC-eligible patients at $21.22 per dose (not per vaccine antigen) for MnVFC vaccine. This fee limit is set by federal law. You may also charge for the office visit.
To be reimbursed for the administration fee for patients enrolled in a Minnesota Heath Care Program (MHCP), you must follow the billing procedures of each program. MHCP programs include Medical Assistance (MA), MinnesotaCare, or a Prepaid Medical Assistance Program (PMAP). For billing questions, call the Minnesota Department of Human Services (DHS) at 651-431-2700.
|Permissible MnVFC vaccine administration fees|
|Patient's status||MnVFC eligible?||Permissible administration fee|
|Medicaid eligible (1)||Yes||$21.22/dose|
|American Indian/Alaska native||Yes||$21.22/dose|
|Underinsured (3)||Only at LPH, FQHC, RHC, IHS, and tribal health clinics
||$21.22/dose at LPH, FQHC, RHC, IHS, and tribal health clinics|
|Privately insured||No||Usual and customary|
|(1) Minnesota Health Care Program (MHCP) enrollee: MN Medical Assistance (MA), MinnesotaCare, or a Prepaid Medical Assistance Program (PMAP)|
|(2) Does not have any insurance|
(3) Patients with private insurance that does not cover the vaccine itself or has a cap. These children are only MnVFC eligible at local public health (LPH), Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Indian Health Services (IHS), and tribal health clinics.
Preventive services like immunizations are often covered even if a deductible remains. If the vaccine is covered or would be denied because they need to pay a deductible, the child will not be considered to be “underinsured” for MnVFC purposes.
Patients that are uninsured, on a MHCP, or are American Indian/Alaska native should have the vaccine charges removed from the bill at all sites that participate in MnVFC.
Underinsured (3) children should have vaccine charges removed if seen at public clinics (LPH, FQHC, RHC, IHS, and tribal health clinics).
MnVFC-eligible patients may not be denied vaccine for failure to pay an administration fee. You may bill a patient for the administration fee, but if they are unable to pay this fee it should be removed from their bill. Having these bills go to collections is not acceptable.
This not only affects the patient’s bill but also their shot record in the statewide immunization registry, which is often derived directly from billing data.
We will be happy to help: 651-201-5522 or 1-800-657-3970.
For billing questions about MHCP programs, call DHS at 651-431-2700.