Q: How is Midwives Advantage different than other billing services?
A: Our business model is unlike any other insurance biller. Midwives Advantage is like a trade union for midwives joining together to do business with insurance payers. Together we are stronger and have better collective bargaining powers than we do individually. Providers become contracted providers of our corporation, and claims process through our corporate agreements. Claims are billed using the corporate tax ID numbers, not the midwife’s social security number or EIN. We process thousands of dollars in claims each year, and as a result, we have a better position with the payers than an individual practitioner or a birth center with several practitioners.
Q: What benefit does Midwives Advantage give me over other billers?
A: We have negotiated agreements for our claims to process at rates above usual and customary. This means our claims pay at higher rates than other billers that do not have these agreements.. The midwife is responsible to accurately report services provided to us but not personally responsible for the way claims are submitted.
Q: Who is responsible for the codes on the claims?
A: The biller is responsible to make sure all billable codes in the health record are submitted accurately on claims.
Q: Can a payer come back on a midwife and demand money for claims previously paid?
A: Using our business model, a payer can not ask a midwife for a refund. Payments are made to the corporation. This structure assures providers that payers will never ask a provider for a refund.
Q: How do providers get paid?
A: The insurance company sends payment to us, we deduct our fees and send the balance to the provider through direct deposit. Payroll is processed every two weeks and funds are deposited into the provider's account on Friday. A spreadsheet of all payments is sent to the midwife every pay day so the midwife is aware which claims have processed.
Q: Can providers charge a different fee for people that pay cash vs. those with insurance?
A: Laws vary from state-to-state but 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 with varying circumstances. In the rare case that this is prohibited, healthcare practitioners legally mitigate this stipulation by offering a pre-payment discount. Ex: If a patient pays upfront or by a deadline, they qualify for a XX% discount. This is no different that negotiating a discount with insurance payers in order to quickly process claims.
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. Documentation is required to submit claims.
Q: Do providers have to use electronic charting?
A: No, electronic records are not required. While many practitioners use electronic health records, a few practices continue to use paper charts.
Q: Are there any payers to whom you don't submit claims?
A: We do not submit Medicaid, Tricare or Medicare.
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 patients advanced warning on this to avoid any confusion regarding the documents they receive from the payer.
Q: Why do EOBs have a different address on them than my normal place of business?
A: EOBs are sent to our corporate offices.
Q: What about claiming income for taxes?
A: The insurance companies send our corporate office a 1099 for all payments we receive and providers receive a 1099 for payments made to them. Providers can access their payment history as well as 1099-MISC documents online through our payroll company.