Q: What advantage do I have being associated with Midwives Advantage vs using other claims submission options for midwives?
A: We have collective agreements with hundreds of payers that were negotiated by an attorney that was part of the $300 million dollar UHC settlement for defrauding members that used out-of-network providers. These agreements allow our claims to pay based on rates established by a third party. This takes "reasonable and customary" charges, that are calculated by insurance companies at very low rates, out of the equation. This is a significant advantage and a much fairer way to submit claims. The provider isn't "making up" a fee for services and the insurance company isn't "making up" a fee. Fair is always the best option.
Q: How do I get paid?
A: Healthcare providers and birth centers are paid on claims every two weeks through direct deposit.
Q: Can I charge a different fee for people that pay cash vs. those with insurance?
A: Laws vary from state-to-state but generally the answer is yes. In-network providers sometimes agree in their contracts to charge cash pay and insurance clients the same rate; however, if you are not bound by a contract, you can use a different fee schedule for clients. In states that this might be prohibited, doctors and alternative healthcare practitioners alike legally work around this stipulation by offering a pre-payment discount. Ex: If a client pays prior to 36 weeks, they qualify for a XX% discount. This same offer can be extended to insurance payers and a provider isn't being unfair.
Q: What are standards for documentation of healthcare services?
A: Medical record documentation standards are established on state and federal levels for professionals that provide health care services. Documentation records need to be legible and chronological.
Q: Do I have to use electronic charting?
A: No, electronic records are not required. While most midwives use electronic health records, a few practices use paper charts.
Q: Are there any payers to whom you don't submit claims?
A: We do not submit Medicaid and BCBS claims are limited. Please ask your billing manager what BCBS claims are acceptable for processing.
Q: Why do some EOBs have a different provider's name on them?
A: Payer software is complex. We have over a hundred providers contracted with our corporation. Some payer software might print our corporate name while others will populate the name of a provider associated with our company. Please let your clients know this is a possibility and not to be concerned if they get an EOB with another name on it. Providers are always welcome to contract us to verify the information on a claim.
Q: Why do some EOBs categorize birth as "surgery"?
A: Insurance payers have a language that many common people don't understand. It is common for payers to describe prenatal care and vaginal delivery as "surgery". The definition of surgery is "the branch of health science that treats diseases, injuries, and deformities by manual or operative methods." Please give your clients advanced warning on this to avoid any confusion following billing.
Q: Why do the EOBs have a Texas address on them?
A: EOBs list a Texas address because our corporate headquarters is located in Texas. Regardless of where the services were provided, EOBs go to the corporate office in Texas. Please call if you have more in-depth questions concerning EOBs. We are always happy to answer questions.
Q: What about claiming income for taxes?
A: The insurance companies send our corporate office a 1099 for all payments we receive and you will receive a 1099 for payments made to you. Providers can access their 1099-MISC anything through our payroll company, GUSTO. Simply login to www.gusto.com using the email address you gave us when you joined our company and click "forgot password". A temporary password will be emailed to you to login to your payment account. We like things that are easy!
Q: Can an insurance company reverse a payment?
A: Yes, in certain circumstances. Sometimes, a claim is paid twice. We do all we can to make sure claims do not get submitted twice; however, occasionally a corrected claim gets processed as an original. If a claim incorrectly pays, our company promptly processes a refund to the correct party.
Q: Who is responsible to pay in the event an insurance company is due a refund?
A: Payments are made to our corporate offices; therefore, our company has to repay any amount that was paid in error or duplication. This is rare, but in the event this does occur, we recoup the fees paid to the provider incorrectly from future payments. All policies are based on integrity and fairness to the patient, provider and payer.