Q: What advantage do I have being employed by Midwives Advantage vs using other claims submission options?
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 more equitable 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: The insurance company sends payment to us and we pay the provider through direct deposit. Payroll is processed every two weeks and funds are deposited into the provider's account on Friday.
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 with varying circumstances. In states that this might be prohibited, doctors and alternative healthcare practitioners alike 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 I have to use electronic charting?
A: No, electronic records are not required. While many practitioners 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, 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 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 are sent to the Texas address. 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 payment history as well as 1099-MISC documents online through our payroll company.
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.